全结肠切除三环型回肠贮袋加选择性截流术疗效评价.docVIP

全结肠切除三环型回肠贮袋加选择性截流术疗效评价 　【摘要】 目的 探讨全结肠切除后三环型回肠贮袋肛管吻合加选择性截流术的价值和疗效。方法 对10余年来20例全结直肠切除的患者应用三环型回肠贮袋加选择性截流术进行分析总结。结果 该手术方法新颖，操作简单，并发症少，发生率为15%(3/20)，由于存在一段逆蠕动肠管和多个环形肠管以及2cm左右的直肠移行带黏膜，故其术后控便功能好，至6个月时都能控制干便，其中正常控制的为80%(16/20)，控制欠佳的为20%(4/20)，无大便失禁；而稀便控制能力较差，至1年时仍有5%(1/20)的患者稀便失禁，无一例需插管排空，平均排便频率低于东方人群同类手术者。结论 全结肠切除后三环型回肠贮袋肛管吻合加选择性截流术是一种简单、安全、并发症少、术后控便功能好的理想术式。 【关键词】 家族性腺瘤性息肉病；溃疡性结肠炎；回肠贮袋；全结肠切除 【Abstract】 Objective To evaluate the application value and prognosis of three-ring ileo-pouch anal anastomosis with selected blocking after total colectomy.Methods 20 colectomic patients who were undergone three-ring ileo-pouch anal anastomosis with selected blocking were analyzed retrospectively.Results Operation with this new method was easy to operate with few complications.The morbidity of complication was 15%(3/20).As there were a section of reversed peristaltic intestine，several intestinal ring and a transitary rectum mucous membrane of 2cm，the control of defecation was well.The percent of the normal continence was 80%(16/20)，the continence is not good enough for 20% (4/20)patient，and no one has fecal incontinence for dry stool after 6 months.There was 5%(1/20) patient with incontinence for loose stool.No patient defecate with intubating.The mean frequence of defecation was lower than those oriental who have congener operations.Conclusion This study shows that ileo-anal anastomosis with three-ring ileo-pouch and selected blocking after total colectomy is an easy，safe，ideal procedure，and has fewer complications and good control over defecation 【Key words】 qamilial adenomatous polyposi；ulcerative colilis；LLeo-pouch；total colectomy 家族性腺瘤NTG 息肉病(familial adenomatous polyposi，FAP)和严重的溃疡性结肠炎(ulcerative colitis，UC)常须全结肠切除。传统的治疗方法是全结肠切除后行永久性回肠人工肛门术，严重影响了患者的生活质量。20年纪80年代相继出现了多种回肠贮袋与肛门或肛管吻合术，取得了一定的疗效，但也存在多种弊端。我院自1994年9月～2005年4月在全结肠切除术中采用自行设计的三环型回肠贮袋加选择性截流的方法治疗FAP和UC共20例，本文就其疗效进行如下评价。 1 资料与方法 1.1 一般资料 本组共20例，FAP 15例，男9例，女6例，年龄25～39岁；UC 5例，男3例，女2例，年龄29～49岁。全组病例均行全结肠切除，以吻合器行