回肠D型储袋在溃疡性结肠炎和家族性腺瘤性息肉病手术治疗中的应用

Application of ileal D-pouch anal anastomosis in the treatment of ulcerative colitis and familial adenomatous polyposis

目的探讨回肠D型储袋在溃疡性结肠炎（UC）和家族性腺瘤性息肉病（FAP）手术治疗中的应用效果。方法回顾性分析2014年10月至2015年3月期间于武汉大学中南医院接受全结直肠切除回肠D型储袋肛管吻合术的6例UC和5例FAP患者的临床及随访资料。术中将回肠断端先与回肠行端侧吻合，再将并拢的两端袢行侧侧吻合，构建的储袋形似“D”形。结果全组11例患者手术时间（225±23）min，储袋构建时间（18±4）min，储袋容积（175±15）ml，术中出血量（110±30）ml，术中直肠穿孔1例。术后住院时间8-11（平均8．5）d。术后2例出现切口感染和脂肪液化，1例出现储袋肛管吻合口阴道瘘，均保守治疗治愈。术后随访1个月，肠镜检查示D型回肠储袋在输入袢处形成圆滑吻合口，吻合口愈合良好；术后1月，Wexner肛门失禁评分（3±2）分，胃肠道生活质量评分（114±11）分。无一例出现储袋炎等储袋相关并发症。结论UC和FAP患者行全结肠直肠切除后，采用回肠D型储袋可消除储袋回肠残端，有效避免了储袋相关并发症的发生。

Objective To evaluate the clinical outcomes of ileal D-pouch anal anastomosis in the treatment of ulcerative colitis （UC） and familial adenomatous polyposis （FAP）. Methods Clinical and follow-up data of 6 UC patients and 5 FAP patients undergoing proctocolectomy and D-ileum pouch anal anastomosis between October 2014 and March 2015 were retrospectively analyzed. End-to-side anastomosis was firstly performed in ileal cutting end and ileum, then side-to-side anastomosis was operated in closing amphi-loop to construct the D-ileum pouch. Results The mean age of the patients was 42 years （range 18 to 61 years）, 5 patients were female. The duration of surgery was （225±3） rain, the operation time to D-ileum pouch was （18±4） rain, the volume of D-ileum pouch was （175± 15） ml, the blood loss was （110±0） ml. There was no procedure-related death, however rectum perforation occurred in 1 male UC patient during operation. The postoperative hospital stay was 8 to 11 days （mean 8.5 days）. The follow-up period was 2 to 7 months （median 3 months）. One female FAP patient suffered from anal anastomosis vagina fistula 21 days after operation. No pouch-related fistula, anastomosis or input loop stricture fecal incontinence, and severe pouchitis were recorded. The defecation frequency was 4 to 6 times per day （UC） and 3 to 5 times per day （FAP） 6 months after operation. No night-time fecal leakage was complained in those patients. Wexner incontinence score was 3±2 and GQLI was 114±11 one month after operation. Clinical outcome in the first month was excellent in 10 patients and good in 1 patient. Conclusions After total colorectal resection for UC and FAP patients, application of D-ileum pouch can clear ileal stump of pouch and avoid the pouch-associated complications effectively.