回肠D型和J型储袋在溃疡性结肠炎及家族性腺瘤性息肉病外科治疗中的比较

Comparison of ileal D - pouch and J - pouch anal anastomosis for patients with ulcerative colitis or familial adenomatous polyposis

目的探讨回肠D型储袋和J型储袋在溃疡性结肠炎（UC）及家族性腺瘤性息肉病（FAP）外科治疗中的应用。方法分析接受全结直肠切除术的UC和FAP患者的临床资料。按照储袋构建方式分为D组（D型储袋）和J组（J型储袋）。D组11例，其中UC6例，FAP5例；J组24例，其中UC20例，FAP4例。结果D组年龄18～61岁；J组年龄21～59岁；D组手术时间[（125±23）min]与J组[（133±39）min]比较差异无统计学意义（P〉0．05）；两组间储袋构建时间[（18±4）min比（22±7）min]，储袋容积[（175±15）比（156±18）ml]，术中出血[（210±30）比（225±35）m1]，差异均无统计学意义（P〉0．05）。D组术中出现直肠穿孔1例，吻合口阴道漏1例；J组出现储袋残端皮肤瘘1例，术后并发硬化性胆管炎1例，重度储袋炎伴出血1例。术后6个月排便频率D组平均4～6次，J组平均5～8次；D组无夜间渗漏，J组有2例出现夜间渗漏。术后6个月Wexner肛门失禁评分D组为（3±2）分，J组评分为（5±2）分（P〈0．05）。结论UC和FAP患者接受全结肠直肠切除后，构建的回肠D型储袋和J型储袋与肛管吻合术后效果相似，回肠D型储袋是一种安全、可供选择的储袋构建方式。

Objective To evaluate the clinical and functional outcomes of ileal D - pouch and J - pouch anal anastomosis for patients with ulcerative colitis （UC） or familial adenomatous polyposis （FAP）. Methods The all 35 patients, including 26 cases of UC and 9 cases of FAP undergoing proctocolectomy between January, 2013 and March, 2015 were retrospectively analyzed. Eleven patients underwent D -ile- um pouch anal anastomosis and 24 J - ileum pouch anal anastomosis. The intra - operation results and Wexner incontinence score （WIS） at 6th month post - operation were analyzed retrospectively. Results The mean age of the patients with D - pouch was 42 years （ range, 18 - 61 years）, and that of the patients with J - pouch was 47 years （ range, 21 - 59 years ）. The operational duration, time creating pouch, vol- ume of pouch and estimated blood loss were comparable in those two groups during operation. One female patient with FAP undergoing D -pouch suffered anal anastomosis vagina leakage on the 21st day post - operation. In patients with J - pouch, there was 1 case of percutaneous pouch fistula, 1 case of primary sclerosing cholangitis and 1 case of severe pouchitis. The defecation frequency was 4 -6 times per day in patients with D - pouch and 5 - 8 times per day in patients with J - pouch at 6th month post - operation. Wexner incontinence scores in patients with D - pouch were less than those with J - pouch （3±2 vs. 5 ±2 ,P 〈 0.05 ）. Conclusion D- ileum pouch is safe and effective, and can be an alternative pouch con- structed model for the treatment of UC and FAP.