结直肠切除术的应用体会

CLINIC APPLICATION OF COLOPROCTECTOMY

目的：探讨全结肠直肠切除术在家族性腺瘤性息肉病（ＦＡＰ）、溃疡性结肠炎（ＵＣ）及结肠克隆病（ＣＣ）外科治疗中的应用。方法：对２２例ＦＡＰ，３例ＵＣ及２例ＣＣ病人施行全结肠直肠切除术，其中回肠贮袋肛管吻合（ＩＰＡＡ）２２例，回肠造口５例。在ＩＰＡＡ中，Ｊ型贮袋３例，Ｈ型贮袋２例，Ｓ型贮袋１７例。就手术适应证、手术操作、术后处理等进行讨论。结果：回肠造口中以加部分回肠倒置者效果较好；ＩＰＡＡ术后排便功能较满意，其中以Ｓ型贮袋为好。结论：全结肠直肠切除术是治疗ＦＡＰ、ＵＣ等的首选术式，而ＩＰＡＡ术后效果较好。

Objective: To evaluate the clinic application of coloproctectomy in familial adenomatous polyposis (FAP), uicerative colitis (UC) and Crohn's disease of colon (CC). Methods: Coloproc- tectomy was performed on the patients of FAP (22 cases), UC (3 cases) and CC (2 cases), of which, ileostomy was performed on 5 cases and ileal pouch-anus anastomosis (IPAA) on 22 cas- es. There were J-pouch 3 cases, H-pouch 2 cases and S-pouch 17 cases in the IPAA. The indica- tion, operative procedure and postoperative treatment were discussed. Results: Ileostomy added with partial ileal inversion was quite good in ileostomy and in the postoperative patients of IPAA, defecative function was good and S-pouch type was better. Conclusion: Total coloproctectomy is best procedure to treat FAP and UC and postoperative effect is better in IPAA.