低位直肠癌前切除术J型储粪袋与常规吻合排便功能比较

目的就低位直肠癌前切除术J型储粪袋与常规吻合排便功能进行比较。方法选取我院2012年1月~2013年1月收治的行低位直肠癌前切除术患者134例,随机分为常吻组（68例）和袋吻组（66例）。常吻组常规用CEEA31型腔内管状吻合器将直肠残端、结肠断端进行端端吻合;袋吻组将断端结肠制成J型储粪袋（5~6cm）,与直肠肛管行端侧吻合。结果袋吻组的平均排便次数、平均大便失禁次数在术后1个月、6个月均明显少于常吻组,袋吻组在术后1个月、6个月的延缓排便能力、需要定期服用缓泻剂和排便控制功能优良等指标也优于常吻组,差异有统计学意义（P〈0.05或P〈0.01）;两组排便功能在术后1年半比较差异无统计学意义（P〉0.05）;两组患者术后并发症比较差异无统计学意义（P〉0.05）,行保守治疗后全部治愈。结论将J型储粪袋应用于低位直肠癌前切除术中,能够有效改善患者排便功能,近期疗效较佳,值得推广。

低位直肠癌前切除术J型储粪袋与常规吻合排便功能比较

目的:探讨低位直肠癌前切除术J型储粪袋与常规吻合对排便功能的影响。方法:回顾性分析我院治疗的124例低位直肠癌患者的临床记录资料,治疗组采用前切除术J型储粪袋吻合,对照组采用常规吻合,观察两组排便功能及并发症的发生情况,并随访6个月。结果:治疗后,治疗组的排便控制功能优良率为95.16%,高于对照组的82.26%,差异具有统计学意义(P<0.05);治疗组术后6个月的平均大便失禁次数、平均排便次数、定期服用缓泻剂例数均明显少于对照组,差异具有统计学意义(P均<0.05);两组术后并发症发生率相比差异无统计学意义(P>0.05)。结论:低位直肠癌前切除术J型储粪袋可有效改善低位直肠癌患者的排便功能,具有推广价值。

再造回肠储粪袋对全结肠切除术后排便的影响

为观察人工再造回肠储粪袋对结肠慢传输型便秘全结肠切除术后排便的影响，将48例结肠慢传输型便秘患者随机分为试验组和对照组，试验组24例采用全结肠切除后回肠末端造J型储粪袋后与直肠吻合治疗，对照组24例不造人工储粪袋。观察两组患者术后的排便情况。结果显示，试验组较对照组大便不成形例数、水样便例数、排便次数明显减少（P〈0．05）。结果表明，人工储粪袋对结肠慢传输型便秘患者全结肠切除术后排便影响很大，可以明显减少长期腹泻情况，提高患者的生活质量。

Fecal microbiota transplantation for Clostridium difficile infection in patients with ileal pouches

Background:Clostridium difficile infection(CDI)in patients with ileal pouch-anal anastomosis(IPAA)has been increasingly recognized.The aim of this study was to evaluate the outcome of fecal microbiota transplantation(FMT)in patients with pouch and CDI.Methods:All consecutive patients that underwent FMT for CDI from 2012 to 2016 were extracted from our IRB-approved,prospectively maintained Registry of Pouch Disorders.The primary outcome was negative stool tests for Clostridium difficile after FMT and the secondary outcomes were symptomatic and endoscopic responses.Results:A total of 13 patients were included in this study,with 10 being Caucasian males(76.9%).All patients had underlying ulcerative colitis for J pouch surgery.After a mean of 2.8±0.8 courses of antibiotic treatments was given and failed,22 sessions of FMT were administered with an average of 1.7±1.1 sessions each.Within the 22 sessions,16 were given via pouchoscopy,4 via esophagogastroduodenoscopy and 2 via enemas.All patients tested negative on C.difficile polymerase chain reaction(PCR)after the initial FMT with a total of 7/12(58.3%)documented patients showed symptomatic improvements and 3/11(27.3%)patients showed endoscopic improvement according to the modified Pouchitis Disease Activity Index.During the follow-up of 1.2±1.1 years,there were a total of five patients(38.5%)that had recurrence after the successful initial treatment and four of them were successfully treated again with FMT.Conclusions:FMT appeared to be effective in eradication of CDI in patients with ileal pouches.However,FMT had a modest impact on endoscopic inflammation and recurrence after FMT and recurrence was common.

Value of routine stool testing for pathogenic bacteria in the evaluation of symptomatic patients with ileal pouches

Background:In symptomatic patients with an ileal pouch,stool studies are often sent to diagnose enteric pathogens.Aim of this study is to find the value of routine stool studies in the evaluation of symptomatic patients and the clinical implications of such pathogens in patients with ileal pouches.Methods:Consecutive ileal pouch-anal anastomosis(IPAA)patients who had stool tests out of a 2283-case registry from 2002 to 2015 were included in the study.Patients with positive stool cultures were compared with controls(symptomatic without positive stool culture)in a 1:4 ratio.Response to antibiotic therapy,recurrence rate and rate of hospitalization at 1 and 3 months were assessed.Results:A total of 643(28%)had stool cultures done and only 1.7%(11/643)were found to be positive for stool cultures.Campylobacter spp.(45%)was the most common pathogen followed by Aeromonas spp.(36%).Non-smokers and patients without any antibiotic use in the last 3 months were found to have higher prevalence of positive stool cultures than controls(p<0.001 and p¼0.023).Patients with pathogenic bacteria were found to have a higher risk of acute kidney injury(27.3%vs 4.5%,p¼0.049),hospitalization within 3 months of initial stool testing(36.4%vs 6.8%,p¼0.009)and mortality(18.2%vs 0%,p¼0.040).However,there were no statistically significant differences in the clinical outcomes in patients with positive stool cultures who received pathogen-directed therapy.Conclusions:We found that the yield of stool tests for bacterial pathogens in symptomatic pouch patients was extremely low and the treatment of detected pathogens had a minimum impact on the disease course of pouchitis.The clinical utility of routine stool culture in those patients warrants further study.