Pouch-related dysplasia and adenocarcinoma following restorative proctocolectomy for ulcerative colitis.
Pouch-related dysplasia and adenocarcinoma following restorative proctocolectomy for ulcerative colitis.
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DOI：
10.1007/s10151-010-0664-2
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发表时间：
2011-03
影响因子：
3.3
通讯作者：
M'Koma, A. E.
中科院分区：
文献类型：
--
作者：
Um, J. W.;M'Koma, A. E.
关键词：
恢复性直肠结肠切除术（RPC）是溃疡性结肠炎（UC）的标准手术治疗方法。恢复性直肠结肠切除术适用于难以接受药物治疗的 UC、紧急情况以及肿瘤转化的情况。该手术大大降低了UC相关的不典型增生/肿瘤的风险。然而，自 1984 年首次报告以来，RPC 手术后，即使进行了粘膜切除术，储袋和/或肛门移行区 (ATZ) 癌症的报告频率也在不断增加。本综述重点介绍了储袋相关的发育不良和肿瘤转化、患病率和不良事件、危险因素和 UC 手术后的监测。我们回顾了截至 2010 年 5 月不同机构报告的有关接受造口袋手术患者的文献报告，以确定发生这些并发症的患者，并尝试根据现有数据制定合理的随访政策。迄今为止，有 43 例 UC RPC 后发生储袋或入口癌症的报道：16 例来自回顾性系列，1 例来自前瞻性研究，26 例来自病例报告。 30 名患者接受了粘膜切除术，13 名患者接受了吻合术。迄今为止，已有 28 名患者在 UC RPC 后被诊断为不典型增生。其中 27 例进行了粘膜切除术，其中 1 例进行了吻合吻合术，但未进行粘膜切除术。在所有审查的病例中，从 UC 发病到不典型增生/肿瘤的时间间隔超过 10 年。 UC 患者 RPC 后发生的肿瘤病变已被证明是绝对不可避免的。即使粘膜切除术也不能完全消除这种风险。除了组织学 C 型改变、硬化性胆管炎和回肠粘膜持续性储袋炎的患者外，几乎没有证据支持对回肠粘膜或肛门移行区进行常规活检。应选择此类患者进行内镜监测，以检测储袋腺癌之前的发育异常。
Restorative proctocolectomy (RPC) is the criterion standard surgical treatment for ulcerative colitis (UC). Restorative proctocolectomy is indicated for UC that is refractory to medical treatment, for emergency conditions, and in case of neoplastic transformation. The procedure substantially reduces the risk of UC-associated dysplasia/neoplasia. However, after RPC surgery, even with mucosectomy, cancers of the pouch and/or the anal-transitional zone (ATZ) have been reported with increasing frequency since the first report in 1984. This review highlights pouch-related dysplastic and neoplastic transformation, prevalence and adverse events, risk factors and surveillance following surgery for UC. Reports in the literature about patients undergoing pouch surgery from different institutions reported through May 2010 were reviewed to identify patients who developed these complications, and an attempt was made to develop a rational follow-up policy based on the data available. To date, there are 43 reported cancers of the pouch or inlet after RPC for UC: 16 from retrospective series, 1 from a prospective study, and 26 in case reports. Thirty patients underwent mucosectomy and 13 had stapled anastomoses. To date, the number of 28 patients has been diagnosed with dysplasia after RPC for UC. Mucosectomy was performed in 27 of them and in 1 a stapled anastomosis was constructed without mucosectomy. In all cases reviewed, the time interval from the onset of UC to dysplasia/neoplasia was over 10 years. Neoplastic lesions occurring in UC patients after RPC have been shown to be absolutely inevitable. Even mucosectomy does not completely eliminate the risk. There is little evidence to support routine biopsy of the ileal mucosa or the anal-transition zone except in patients with histological type C changes, sclerosing cholangitis, and unremitting pouchitis in the ileal mucosa. Such patients should be selected for endoscopic surveillance to detect dysplasia preceding pouch adenocarcinoma.
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