The Evolution of Prophylactic Colorectal Surgery for Familial Adenomatous Polyposis
The Evolution of Prophylactic Colorectal Surgery for Familial Adenomatous Polyposis
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DOI：
10.1007/dcr.0b013e3181ab58fb
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发表时间：
2009-08-01
影响因子：
3.9
通讯作者：
Burke, Carol A.
中科院分区：
文献类型：
--
作者：
Moreira, Andre da Luz;Church, James M.;Burke, Carol A.
简介：在过去的50年里，随着新技术和新理念的出现，家族性腺瘤性息肉病患者的预防性结直肠手术也在不断发展。本研究的目的是审查所有的指数手术家族性腺瘤性息肉病在我们的机构进行评估的变化在外科technology.METHODS：所有指数腹部手术息肉病从1950年至2007年通过息肉病登记数据库。我们将患者分为前囊（1983年前），囊（1983年后），腹腔镜（1991年后）时代，并分析了预防性手术的变化。手术时的中位年龄为26岁（范围，9-66岁）。在前袋时代，97%（66/68）的所有手术和100%的修复手术是回肠直肠吻合术。1983年后，70%（54/77）的重度表型患者行回肠贮袋-肛门吻合术。1991年后，110例手术（43%）是腹腔镜（88回肠直肠和22回肠袋肛门吻合术）。结论：结肠手术家族性腺瘤性息肉病的发展，在外科技术的进步创造了更多的选择，以减少癌症的风险。目前的策略是根据息肉病的严重程度和分布来决定手术方案，并通过腹腔镜手术来减少发病率。
INTRODUCTION: Over the past 50 years, prophylactic colorectal surgery for patients with familial adenomatous polyposis has evolved as new technologies and ideas have emerged. The aim of this study was to review all the index surgeries for familial adenomatous polyposis performed at our institution to assess the changes in surgical techniques.METHODS: All index abdominal surgeries for polyposis from 1950 to 2007 were identified through the Polyposis Registry Database. We assigned the patients to prepouch (before 1983), pouch (after 1983), and laparoscopic (after 1991) eras, and analyzed the changes in prophylactic surgery.RESULTS: Four hundred twenty-four patients were included; 51% were male. Median age at surgery was 26 (range, 9-66) years. In the prepouch era, 97% (66 of 68) of all surgeries and 100% of restorative surgeries were ileorectal anastomosis. After 1983, 70% (54 of 77) of patients with a severe phenotype had an ileal pouch-anal anastomosis. After 1991, 110 operations (43%) were laparoscopic (88 ileorectal and 22 ileal pouch-anal anastomosis).CONCLUSION: Colon surgery for familial adenomatous polyposis has evolved as advances in surgical technique have created more options to reduce the risk of cancer. Current strategy uses polyposis severity and distribution to decide on the surgical option, and laparoscopy to minimize morbidity.