AN ASSESSMENT OF INFLAMMATION IN THE RESERVOIR AFTER RESTORATIVE PROCTOCOLECTOMY WITH ILEOANAL ILEAL RESERVOIR
AN ASSESSMENT OF INFLAMMATION IN THE RESERVOIR AFTER RESTORATIVE PROCTOCOLECTOMY WITH ILEOANAL ILEAL RESERVOIR
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DOI：
10.1007/bf01648445
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发表时间：
1986-01-01
影响因子：
2.8
通讯作者：
NICHOLLS, RJ
中科院分区：
文献类型：
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作者：
MOSKOWITZ, RL;SHEPHERD, NA;NICHOLLS, RJ
恢复性直肠切除术后回肠回肠粘膜炎症的重要性尚不清楚，但在某些情况下，它似乎与被称为粘液炎的症状有关。这项调查的目的是确定炎症的患病率，确定膀胱炎的定义，并检查可能与炎症相关的一些因素。对90例回肠造口闭合后62个月的回肠粘膜活检进行了研究。用组织学分级系统(0-6)评估炎症的严重程度。87%的病例有不同程度的慢性炎症，30%的病例有急性炎症。4级及以上的患病率分别为23%和3.5%。慢性炎症的严重程度与急性炎症的严重程度相关。严重的组织学急性炎症(4-6级)与乙状结肠镜下的炎症特征和排便频率增加相关。在55例乙状结肠镜检查的患者中，6例(11%)有膀胱炎，其特征是储液池的肉眼炎症、腹泻和组织学分级4级或以上。慢性炎症的严重程度与排便次数无关。组织学炎症与贮器的类型、排出已知容量的代用品排出后的残留量或贮器的顺应性无关。溃疡性结肠炎患者的急性炎症明显比家族性腺瘤性息肉病患者严重。
The significance of inflammation of the mucosa of the ileal reservoir after restorative proctocolectomy is not known although in some cases it appears to be associated with symptoms when the condition has been referred to as pouchitis. This investigation has aimed to determine the prevalence of inflammation, to define pouchitis and to examine some factors which might be related to inflammation. Mucosal biopsies from the ileal reservoir were studied in 90 patients at up to 62 months after closure of the ileostomy. A histological grading system (0–6) was used to assess the severity of inflammation. Some degree of chronic and acute inflammation was found in 87% and 30% of cases respectively. The prevalence of a grade of 4 or more was 23% and 3.5%. There was a correlation between severity of chronic and acute inflammation. Severe histological acute inflammation (grade 4–6) was associated with sigmoidoscopic features of inflammation and with increased frequency of defaecation. Of 55 patients sigmoidoscoped by one clinician, 6 (11%) had pouchitis which was characterised by macroscopic inflammation of the reservoir, diarrhoea and a histological grade of 4 or more. The severity of chronic inflammation was not related to frequency of defaecation. Histological inflammation could not be correlated with the type of reservoir, residual volume after evacuation of a known volume of stool substitute introduced per anum into the reservoir or compliance of the reservoir. Acute inflammation was significantly more severe in patients with ulcerative colitis than in those with familial adenomatous polyposis.