Outcome after proctocolectomy with heal pouch-anal anastomosis for ulcerative colitis
Outcome after proctocolectomy with heal pouch-anal anastomosis for ulcerative colitis
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DOI：
10.1002/ibd.20278
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发表时间：
2008-01-01
影响因子：
4.9
通讯作者：
D'Hoore, Andre
中科院分区：
文献类型：
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作者：
Ferrante, Marc;Declerck, Sarah;D'Hoore, Andre
背景资料：在他们的疾病过程中，约30%的溃疡性结肠炎（UC）患者将接受直肠结肠切除术与回肠袋肛门吻合术（IPAA）。我们在比利时转诊中心评估了IPAA的结果。研究方法：对1990-2004年接受IPAA的所有UC（n = 182）和不确定性结肠炎（n = 2）患者的术前和术后病程、功能结局和并发症的临床图表进行了审查。结果：184例患者中有173例获得随访数据（67例女性，直肠结肠切除术时的中位年龄为39.0岁）。IPAA后1年的中位功能Orestand评分为3（范围0-11）。27%的患者出现术后早期并发症。中位（四分位距）随访6.5（3.4-9.9）年后，35%的患者发生脓毒性和/或阻塞性并发症。46%的患者至少发生1次结肠袋炎。结肠袋炎的危险因素是存在肠外表现（比值比[OR] 1.92（1.23-3.01），P = 0.004）和直肠结肠切除术时年龄较小（P = 0.004）。33例患者存在慢性结肠袋炎，与肠外表现（OR 2.93（1.13-7.62），P = 0.027）、回肠炎（OR 9.28（1.71-50.49），P = 0.010）和随访时间（P = 0.004）相关。5%的患者发生包装袋失效。结论：虽然直肠结肠切除术与IPAA手术具有良好的功能结局，但UC患者的术后并发症，尤其是结肠袋炎，仍然相当严重。
Background: During the course of their disease, about 30% of patients with ulcerative colitis (UC) will undergo proctocolectomy with ileal pouch-anal anastomosis (IPAA). We evaluated the outcome of IPAA in a Belgian referral center. Methods: Clinical charts were reviewed for pre- and postoperative disease course, functional outcome, and complications in all patients with UC (n = 182) and indeterminate colitis (n = 2) who underwent IPAA in 1990-2004. Results: Follow-up data were available in 173 out of 184 patients (67 female, median age at proctocolectomy 39.0 years). Median functional Orestand score 1 year after IPAA was 3 (range 0-11). Early postoperative complications were seen in 27% of patients. After a median (interquartile range) follow-up of 6.5 (3.4-9.9) years, 35% of patients developed septic and/or obstructive complications. Forty-six percent of patients developed at least 1 episode of pouchitis. Risk factors for pouchitis were the presence of extraintestinal manifestations (odds ratio [OR] 1.92 (1.23-3.01), P = 0.004) and younger age at proctocolectomy (P = 0.004). Chronic pouchitis was present in 33 patients and associated with extraintestinal manifestations (OR 2.93 (1.13-7.62), P = 0.027), backwash ileitis (OR 9.28 (1.71-50.49), P = 0.010), and length of follow-up (P = 0.004). Pouch failure occurred in 5% of patients. Conclusions: Although proctocolectomy with IPAA surgery has a good functional outcome, postoperative complications, especially pouchitis, remain considerable in patients with UC.