摘要
PURPOSE: This study was designed to determine the outcome of patients with Crohn’ s disease and indeterminate colitis who have an ileal pouch- anal anastomosis. METHODS: Between 1982 and 2001, 1,270 patients underwent a restorative proctocolectomy at the Mount Sinai Hospital: 1,135 had ulcerative colitis, 36 had Crohn’ s disease, 21 had indeterminate colitis, and 78 had another diagnosis. Perioperative data were collected prospectively. Functional outcomes were assessed with a 35- question survey mailed to all patients with a functioning pouch of at least six months duration. RESULTS: Pouch complications were significantly more common in patients with Crohn’ s disease (64 percent) and indeterminate colitis (43 percent) compared with patients with ulcerative colitis (22 percent) (P < 0.05). Similarly, 56 percent of patients with Crohn’ s disease had their pouch excised or defunctioned, compared with 10 percent of patients with indeterminate colitis and 6 percent with ulcerative colitis (P < 0.01). In the subgroup of patients with a diagnosis of Crohn’ s disease, multivariate analysis revealed that the pathologist’ s initial designation of ulcerative colitis (based on the colectomy specimen) and an increasing number of pathologic, clinical, and endoscopic features of Crohn’ s disease were independently associated with pouch failure. The functional results in patients with Crohn’ s disease with a successful pouch were not significantly different from those with indeterminate colitis or ulcerative colitis. CONCLUSIONS: Although complication rates may be higher in patients with indeterminate colitis compared with ulcerative colitis, the overall pouch failure rate is similar. On the other hand, more than one- half of patients with Crohn’ s disease will require pouch excision or diversion. Our data suggest that it is difficult to identify patients with Crohn’ s disease who are likely to have a successful outcome after restorative proctocolectomy. Thus, Crohn’ s disease should remain a relative contraindication to restorative proctocolectomy, whereas ileal pouch- anal anastomosis is an acceptable alternative for patients with indeterminate colitis.
PURPOSE: This study was designed to determine the outcome of patients with Crohn' s disease and indeterminate colitis who have an ileal pouch- anal anastomosis. METHODS: Between 1982 and 2001, 1,270 patients underwent a restorative proctocolectomy at the Mount Sinai Hospital: 1,135 had ulcerative colitis, 36 had Crohn' s disease, 21 had indeterminate colitis, and 78 had another diagnosis. Perioperative data were collected prospectively. Functional outcomes were assessed with a 35- question survey mailed to all patients with a functioning pouch of at least six months duration. RESULTS: Pouch complications were significantly more common in patients with Crohn' s disease (64 percent) and indeterminate colitis (43 percent) compared with patients with ulcerative colitis (22 percent) (P < 0.05). Similarly, 56 percent of patients with Crohn' s disease had their pouch excised or defunctioned, compared with 10 percent of patients with indeterminate colitis and 6 percent with ulcerative colitis (P < 0.01). In the subgroup of patients with a diagnosis of Crohn' s disease, multivariate analysis revealed that the pathologist' s initial designation of ulcerative colitis (based on the colectomy specimen) and an increasing number of pathologic, clinical, and endoscopic features of Crohn' s disease were independently associated with pouch failure. The functional results in patients with Crohn' s disease with a successful pouch were not significantly different from those with indeterminate colitis or ulcerative colitis. CONCLUSIONS: Although complication rates may be higher in patients with indeterminate colitis compared with ulcerative colitis, the overall pouch failure rate is similar. On the other hand, more than one- half of patients with Crohn' s disease will require pouch excision or diversion. Our data suggest that it is difficult to identify patients with Crohn' s disease who are likely to have a successful outcome after restorative proctocolectomy. Thus, Crohn' s disease should remain a relative contraindication to restorative proctocolectomy, whereas ileal pouch- anal anastomosis is an acceptable alternative for patients with indeterminate colitis.
