腹腔镜辅助下回肠储袋与直肠肌管吻合术治疗家族性腺瘤性息肉病的临床体会

Clinical application of laparoscopic-assisted ileal pouch and rectal muscle tube anastomosis in the treatment of familial adenomatous polyposis

目的:探讨腹腔镜辅助下回肠储袋与直肠肌管吻合术治疗家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)的临床价值。方法:回顾分析2006～2011年为13例FAP患者分别行腹腔镜辅助回肠储袋与直肠肌管吻合术及回肠储袋与肛管吻合术的临床资料,并进行对比分析。结果:两组患者手术时间、术中出血量、术后切口长度、进食时间、住院时间、住院费用差异均无统计学意义。术后6个月随访,腹腔镜辅助下回肠储袋与直肠肌管吻合术较回肠储袋肛管吻合术后患者排便次数明显减少,肛管静息压及最大收缩压明显增高。结论:与传统回肠储袋肛管吻合术相比,回肠储袋直肠肌管吻合手术保留了部分直肠肌管,不仅有效减少了盆底肌肉损伤的可能性,而且很好地保护了肛门括约肌,因而可更好地保留患者的控排便功能。

Objective：To study the application of laparoscopic-assisted ileal pouch and rectal muscle tube anastomosis in the treatment of familial adenomatous polyposis（FAP）. Methods：A retrospective statistical analysis of thirteen cases of FAP patients from our department during 2006-2011 underwent laparoscopic-assisted ileal pouch and rectal muscle tube anastomosis and ilial pouch-analcanal anastomosis surgical procedures was performed and compared. Results： There were no differences in the operation time, amount of bleeding, length of incision, time for returning to diets, average stay and average hospitalization expense between two groups. Six-month follow-up data showed that laparoscopic-assisted ileal pouch under the rectal muscle tube anastomosis was safe and reliable. Compared with ileal pouch anal anastomosis, patients underwent ileal pouch and rectal muscle tube anastomosis has significantly reduced defeca- tion frequency and significantly increased anal resting pressure and anal maximal contraction pressure. Conclusions ： Operation of ileal pouch rectal muscle tube anastomosis effectively reduced the injury of the pelvic floor muscles and anal sphincter, therefore the opera- tion is effective in restoring defecation and urination function.