Preoperative terminal ileal and colonic resection histopathology predicts risk of pouchitis in patients after ileoanal pull-through procedure.
Preoperative terminal ileal and colonic resection histopathology predicts risk of pouchitis in patients after ileoanal pull-through procedure.
复制标题
术前回肠末端和结肠切除组织病理学可预测回肠肛门拉通手术后患者发生储袋炎的风险。
DOI：
10.1097/00000658-199805000-00006
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发表时间：
1998
影响因子：
9
通讯作者：
Sitzmann,JV
中科院分区：
文献类型：
--
作者：
Schmidt,CM;Lazenby,AJ;Hendrickson,RJ;Sitzmann,JV
目的比较回肠和结肠末端切除标本与回肠肛门拉通术(IAPT)后膀胱镜活检的组织病理学改变。摘要背景资料：膀胱炎是IAPT术后最常见的经肛管可控储水池并发症。在这份初步报告中，病理学家以盲法对468例IAPT囊活检和67例患者术前末端回肠和结肠切除的组织病理学进行了分级。结果结肠病变的程度(大体和显微镜下)是IAPT囊活检标本炎症活动的重要预测指标。此外，结肠疾病的大体范围与膀胱炎呈显著的线性相关。然而，结肠疾病的严重程度并不能显著预测随后的IAPT囊活检中的活动性炎症。回肠末端活动性和慢性炎症是随后IAPT膀胱炎的重要预测因素。虽然淋巴细胞聚集和上皮内淋巴细胞不能预测，但回肠末端嗜酸性粒细胞和绒毛钝化是随后的IAPT囊活检标本中活动性炎症的显著预测因素。结论术前末端回肠和结肠组织病理学检查预测IAPT后袋的活动性炎症。术前被评估为有广泛的结肠疾病、回肠疾病(“反冲洗回肠炎”)或两者兼有的患者，在IAPT后发生膀胱炎的风险似乎更大。
Objective This study seeks to compare the histopathology of preoperative terminal ileal and colonic resection specimens with pouch biopsies after the ileoanal pull-through (IAPT) procedure.Summary Background Data Pouchitis is the most frequent complication of transanal continent reservoirs in patients after IAPT.Methods The authors conducted 751 consecutive pouch biopsies on 73 patients with inflammatory bowel disease or familial adenomatous polyposis who underwent IAPT by a single surgeon over a 10-year period. In this preliminary report, a pathologist, in blinded fashion, has graded 468 of the IAPT pouch biopsies and 67 of the patients' preoperative terminal ileal and colonic resection histopathology to date. Colonic histopathology was graded by the extent and severity of disease, terminal ileal and pouch histopathology by active inflammation, chronic inflammation, lymphocyte aggregates, intraepithelial lymphocytes, eosinophils, and villous blunting.Results Extent of colonic disease (gross and microscopic) was a significant predictor of active inflammation in subsequent IAPT pouch biopsy specimens. Also, the gross extent of colonic disease exhibited a significant linear association with pouch inflammation. However, the severity of colonic disease was not significantly predictive of active inflammation in subsequent IAPT pouch biopsies. Terminal ileal active and chronic inflammation were significant predictors of subsequent IAPT pouch inflammation. Although lymphocyte aggregates and intraepithelial lymphocytes were not predictive, terminal ileum eosinophils and villous blunting were significant predictors of active inflammation in subsequent IAPT pouch biopsy specimens.Conclusions Preoperative terminal ileal and colonic histopathology predicts active inflammation of pouches after IAPT. Patients who are preoperatively assessed to have extensive disease of the colon, ileal disease (" backwash ileitis"), or both appear to be at greater risk for the development of pouchitis after IAPT.