中国实用外科杂志

中国实用外科杂志 ›› 2022, Vol. 42 ›› Issue (11): 1276-1285.DOI: DOI:10.19538/j.cjps.issn1005-2208.2022.11.17

• 论著 • 上一篇    下一篇

溃疡性结肠炎全结直肠切除回肠储袋肛管吻合术不同长度J型储袋临床疗效研究

许伟民1，丁文俊1，朱怡莲1，王垚晟1，华哲斌1，蔡泽荣2，崔    龙1，吴小剑2，练    磊2，丁    召3，杜    鹏1   

  1. 1上海交通大学医学院附属新华医院结直肠外科，上海200092；2 中山大学附属第六医院胃肠外科，广东广州510655；3武汉大学中南医院结直肠肛门外科，湖北武汉430071
  • 出版日期:2022-11-01 发布日期:2022-11-18

  • Online:2022-11-01 Published:2022-11-18

摘要： 目的    分析比较溃疡性结肠炎（UC）病人行全结直肠切除回肠储袋肛管吻合术（TPC-IPAA）构建不同长度J型储袋对术后并发症及远期生活质量的影响。方法    回顾性收集自2008年1月至2021年6月在上海交通大学医学院附属新华医院结直肠外科、中山大学附属第六医院胃肠外科、武汉大学中南医院结直肠肛门外科3家中心接受TPC-IPAA手术的130例UC病人临床资料。根据3家单位储袋长度分布，将储袋长度为（22±2）cm 及（14±2）cm的病人分为长储袋组（76例）和短储袋组（54例），分析两组病人TPC-IPAA术后并发症及远期生活质量。结果    长储袋组病人术后总体克利夫兰生活质量评分（CGQL）及术后CGQL较术前评分提高50%者所占比例均显著高于短储袋组病人［（0.700±0.123） vs.（0.756±0.129），t=-2.454，P = 0.015； 42.6% vs.62.5%，χ2=6.117，P = 0.013］。 此外，短储袋组术后发生远期并发症病人占所比例较长储袋组高（51.9% vs. 30.3%，χ2=6.172，P = 0.013），主要包括排便次数增加（22.2% vs. 7.9%，χ2=5.433，P = 0.020）及发生储袋炎（40.7% vs. 21.1%，χ2=5.915，P = 0.015）。多元Logistic回归分析结果显示，储袋长度（14 ± 2 ）cm是影响术后远期生活质量及TPC-IPAA术后远期并发症发生的独立危险因素。Kaplan-Meier生存分析结果显示短储袋组病人的无TPC-IPAA术后远期并发症总体生存率低于长储袋组（P < 0.0001）。结论    J型储袋的储袋长度与UC病人TPC-IPAA术后的临床预后密切相关。长度为（22 ± 2） cm的储袋可考虑作为储袋构建的选择，以减少术后远期并发症发生并显著提高远期生活质量。

关键词: 回肠储袋肛管吻合术, 溃疡性结肠炎, 储袋长度, 术后并发症, 生活质量

Abstract: Effects of different lengths of J pouch in patients with ulcerative colitis after total proctocolectomy with ileal pouch-anal anastomosis        XU Wei-min *, DING Wen-jun , ZHU Yi-lian, et al.*Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University,School of Medicine, Shanghai 200092, China
Corresponding author: DU Peng, E-mail: dupeng@xinhuamed.com.cn
XU Wei-min and DING Wen-jun are the first authors who contributed equally to the article
Abstract    Objective    To analyze and compare the complications after total proctocolectomy with ileal pouch-anal anastomosis (TPC-IPAA) and long-term quality of life (QOL) in patients with ulcerative colitis (UC) with J pouch configuration of different lengths. Methods Clinical data of 130 UC patients who underwent TPC-IPAA from January 2008 to June 2021 in Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University and Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University were retrospectively collected. The pouches with a length of about  (22 ± 2) cm (76 patients) and (14 ± 2) cm (54 patients) were divided into the short and the long J pouch groups according to the length distribution of pouches. Then the postoperative complications and long-term QOL were analyzed in the two groups. Results    The overall Cleveland Quality of life score (CGQL) and the proportion of patients with CGQL increased by 50% after IPAA were significantly higher in long J pouch group than those in short J pouch group ［(0.700±0.123) vs. (0.756±0.129), t=-2.454, P=0.015; 42.6% vs. 62.5%, χ2=6.117, P=0.013］. The proportion of postoperative long-term complications in the short J pouch group was higher than that in the long J pouch group (51.9% vs. 30.3%, χ2=6.172, P=0.013), which mainly included increased defecation frequency (22.2% vs. 7.9%, χ2=5.433, P=0.020) and pouchitis (40.7% vs. 21.1%, χ2=5.915, P=0.015). Multiple logistic regression analysis showed that pouch length of (14 ± 2) cm was an independent risk factor for impaired long-term QOL and the development of late complications after TPC-IPAA. Kaplan-Meier survival analysis showed that the overall late postoperative complications-free survival after TPC-IPAA was lower in short J pouch group than that in long J pouch group (P<0.0001). Conclusion    The length of J pouch, was associated with the clinical outcomes in patients after TPC-IPAA. A pouch with a length of 22 ± 2 cm could be taken into consideration to create in clinical practice for colorectal surgeons, which could reduce the incidence of late complications and make patients achieve a better long-term prognosis.

Key words: ileal pouch-anal anastomosis, ulcerative colitis, the length of J pouch, postoperative complications, quality of life