Different Result of Restorative Proctocolectomy between Polyposis Coli and Ulcerative Colitis-A Single Surgeon's Experience

復原式結腸直腸切除手術治療家族性大腸息肉症及潰瘍性大腸炎的結果及併發症之比較－單一外科醫師的經驗

周育德(Yu-Te Chou) ； 許自齊(Tzu-Chi Hsu) ； 陳明仁(Ming-Jen Chen)

《中華民國大腸直腸外科醫學會雜誌》 26卷2期 (2015/06) Pp. 51-56

https://doi.org/10.6312/SCRSTW.2015.26(2).10330

摘要

目的　家族性大腸息肉症通常採用外科療法以預防大腸息肉的惡性變化，而潰瘍性大腸炎則是針對其所造成的併發症採用外科療法。這篇回顧性研究分析，主要是呈現單一外科醫師對家族性大腸息肉症及潰瘍性大腸炎採用復原式結腸直腸切除術的結果及併發症作探討。方法　從1983年12月到2010年12月，共收集46位罹患大腸腺瘤及44位潰瘍性大腸炎患者，其中22位大腸腺瘤及25位潰瘍性大腸炎患者接受復原式結腸直腸切除術，這些患者手術都由同一位外科醫師執行。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、手術併發症及死亡率。結果　針對家族性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歲，開刀術式為復原式結腸直腸切除術共計有22位。治療追蹤期間術後併發症最常見的是腸道阻塞共計有8位（36.3%），其次為上消化道出血共計有3位（13.6%）。而有4位病人因術後併發症而再次接受手術。針對潰瘍性大腸炎患者的收集，共計有男性24位及女性20位。平均年齡為46.4歲，開刀術式為復原式結腸直腸切除術共計有25位。治療追蹤期間術後併發症最常見的是腸道阻塞共計有5位（20%），其次為傷口感染共計有5位（20%），直腸陰道廔管共計有3位（12%），骨盆腔膿瘍共計有2位（8%），迴腸袋穿孔共計有1位（4%），而迴腸袋發炎共計有5位（20%）。而有6位病人因術後併發症而接受迴腸袋切除手術。結論　預防性結腸切除術是目前家族性大腸息肉症患者預防大腸直腸癌發生的最佳治療方式，而手術對於潰瘍性大腸炎則是針對其產生的併發症。雖然採用復原式結腸直腸切除手術能提供患者術後較理想的生活品質，但其手術併發症的代價相對是較高的，所以應視患者情況及手術醫師的經驗做最適當的選擇。

關鍵字

家族性大腸息肉症 ； 潰瘍性大腸炎 ； 復原式結腸直腸切除術

並列摘要

Purpose. Early operation is recommended for patients with adenomatous polyposis coli because cancer will develop in 100% of patients if untreated. Surgery is reserved for treating complications of ulcerative colitis (UC). This is a retrospective analysis of surgical results of restorative protocolectomy with ileal pouch anal anastomosis (IPAA), performed by a single surgeon (TCH) for patients with adenomatous polyposis coli and ulcerative colitis in a period of 27 years. Materials and Methods. A total of 44 patients with adenomatous polyposis coli and two patients with juvenile polyposis coli were operated from 1983 to 2010. Twenty-three patients were male, and 23 patients were female. Age ranged from 11 to 58 years old (an average age of 34.2 years old). Twenty-two cases of adenomatous polyposis coli received restorative proctocolectomy with IPAA. A total of 44 patients with ulcerative colitis were operated by the same surgeon. Twenty four were male and 20 were female. Age ranged from 16 to 74 years (an average age of 46.4 years old). Restorative proctocolectomy with IPAAwas performed for 25 patients. Results. In the patients with adenomatous polyposis coli, four patients were re-explored postoperatively for postoperative complications, a patient did not have the ileostomy closed, a patient died of metastatic cancer, and a patient died of non-cancer cause. 19 patients (86%) had good function of pouch. Complications of the patients with UC included intestinal obstruction in five patients (20%), wound infection in five patients (20%), rectovaginal fistula in three patients (12%), pelvic abscess in two patients (8%), pouch perforation in one patient (4%) and pouchitis in five patients (20%). Six patients had pouch removed for various complications. 16 patients (64%) had good function of pouch. Conclusion. Restorative proctocolectomy with IPAAis not a perfect operation, but could offer reasonable good quality of life among 86% of our patients with adenomatous polyposis coli. Only 64% of our patients with ulcerative colitis had good pouch function after restorative proctocolectomy with IPAA. Although IPAAmay offer fair to good quality of life, the price is high while such an operation was offered to the patients especially in patients with ulcerative colitis.

並列關鍵字

Adenomatous polyposis coli ； Ulcerative colitis ； Restoratvie proctocolectomy

參考文獻

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