- 期刊
Surgical Management of Adenomatous and Juvenile Polyposis Coli-A Single Surgeon's Experience
外科手術治療大腸腺瘤及青年息肉症的經驗
摘要
目的 大腸腺瘤及青年性息肉症通常採用外科療法以預防大腸息肉的惡性變化。對於大多數的臨床醫師來說，由於息肉症在台灣地區的發生率不高，因此息肉症之手術治療的經驗的確比較缺乏。這篇回顧性研究分析，主要是呈現單一外科醫師對大腸腺瘤及青年性息肉症的手術經驗。方法 從1984年2月到2010年12月，共收集46位罹患腺瘤及青年性息肉症患者資料，這些患者都接受同一位外科醫師的手術治療。這些研究資料包括患者的流行病學資料、手術治療的適應症、手術術式、手術併發症及死亡率。結果 針對大腸息肉症患者的收集，共計有男性23位及女性23位。平均年齡為34.2±11.7歲。最常見的開刀適應症為惡性腫瘤共有32位（69.6%），其次為只有大腸息肉症共有13位（30.8%）。最常見的開刀術式為復原式結腸直腸切除術共計有22位（47.8%），其次為全結腸直腸切除術併迴腸造瘻共計有9位（19.6%），及次全結腸切除併腸吻合共計有5位（10.9%）。治療追蹤期間共有18位患者死亡，其平均年齡為43.0±11.1歲。術後併發症最常見的是腸道阻塞共計有8位（17.4%），其次為上消化道出血共計有3位（6.5%）。結論 預防性結腸切除術是目前大腸腺瘤及青年性息肉症患者預防大腸直腸癌發生的最佳治療方式，但決定採用何種術式，應視患者情況做最適當的選擇。
並列摘要
Purpose: Early operation is recommended for patients with polyposis coli because cancer will develop in 100% of patients if untreated. This is a retrospective analysis of a single surgeon's experience of surgical management of polyposis coli in a period of 25 years.Materials and Methods: From 1984 to 2010, 46 cases of polyposis coli were operated by a single colorectal surgeon (TCH). There were 44 patients with adenomatous polyposis coli and two patients with juvenile polyposis coli. Twenty-three patients were male, and 23 patients were female. Age ranged from 11 to 58 years old, with an average of 34.2 years old. Three patients had colectomies for polyposis coli previously.Results: Restorative proctocolectomy (IPAA) was performed in 22 patients, followed by total proctocolectomy with ileostomy in nine patients and subtotal colectomy with ileorectal anastomosis in five patients. Thirty-two patients were found to have invasive adenocarcinoma in the specimen. Four patients were re-explored postoperatively for postoperative complications. Thirteen patients died of metastatic colorectal cancer and four patients died of cause other than cancer. Within the group of patients who had IPAA, a patient did not have the ileostomy closed, a patient died of metastatic cancer, and a patient was a non cancer death years later. There were 19 patients with good function of pouch. One patient is currently receiving treatment of desmoid tumor.Conclusion: Colectomy should be recommended to all patients with polyposis coli to avoid death due to colorectal carcinoma. Restorative proctocolectomy is not a perfect operation, but can offer a reasonable good quality of life to the patient with polyposis coli if the operation is successful.