Crohn's disease and indeterminate colitis and the ileal pouch-anal anastomosis: Outcomes and patterns of failure
Crohn's disease and indeterminate colitis and the ileal pouch-anal anastomosis: Outcomes and patterns of failure
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DOI：
10.1007/s10350-005-0059-z
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发表时间：
2005-08-01
影响因子：
3.9
通讯作者：
McLeod, RS
中科院分区：
文献类型：
--
作者：
Brown, CJ;MacLean, AR;McLeod, RS
目的：本研究旨在确定克罗恩病和不明原因结肠炎患者行回肠袋-肛管吻合术的预后。方法：1982-2001年间，在西奈山医院接受了1270例恢复性直肠切除术：1135例为溃疡性结肠炎，36例为克罗恩病，21例为不明原因结肠炎，78例为其他诊断。前瞻性收集围手术期数据。通过邮寄给所有有至少6个月功能袋的患者的35个问题的调查来评估功能结果。结果：克罗恩病(%)和不明原因结肠炎(43%)患者的肠袋并发症发生率明显高于溃疡性结肠炎(22%)(P<；0.05)。同样，56%的克罗恩病患者的肠袋被切除或切除，相比之下，不明原因结肠炎患者和溃疡性结肠炎患者的这一比例分别为10%和6%(P<；0.01)。在诊断为克罗恩病的患者亚组中，多变量分析显示，病理学家最初指定的溃疡性结肠炎(基于结肠切除标本)和越来越多的克罗恩病的病理、临床和内窥镜特征与胃袋衰竭独立相关。囊成功的克罗恩病患者的功能结果与不确定结肠炎或溃疡性结肠炎患者没有显著差异。结论：尽管不明原因结肠炎患者的并发症发生率可能高于溃疡性结肠炎患者，但总体上袋子失败率是相似的。另一方面，超过一半的克罗恩病患者将需要切除或转移眼袋。我们的数据表明，很难确定克罗恩病患者在恢复性直肠切除术后有可能获得成功的结果。因此，克罗恩病应该仍然是恢复性直肠切除术的相对禁忌症，而回肠袋-肛门吻合术对于不确定结肠炎患者来说是一种可接受的选择。
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.