目的 评价全结直肠切除回肠贮袋肛管手缝吻合术(HIPAA)治疗溃疡性结肠炎的临床价值.方法 回顾性分析1989年1月至2013年12月天津医科大学总医院收治的191例溃疡性结肠炎患者的临床资料,采用开腹和腹腔镜辅助手术行HIPAA.末次手术后3个月和12个月进行问卷调查,依据24h和夜间排便次数、Bristol粪便分类表和Kirwan分级评价贮袋肛门功能.依据克利夫兰生命质量表评价生命质量;依据贮袋炎活动指数诊断贮袋炎.随访时间截至2014年4月.独立样本比较采用t检验,多组比较采用方差分析,两两比较采用LSD-t检验,计数资料比较采用x2检验.结果 191例患者中有180例行开腹手术,11例行腹腔镜手术.175例行二期手术,9例行一期手术,7例行三期手术.181例采用J型贮袋,9例采用H型贮袋,1例采用W型贮袋.患者无围手术期死亡,术后早期8例患者腹腔感染,7例切口感染,应用抗生素后治愈.术后1～2周发生贮袋吻合口出血4例,吻合口漏4例,给予止血处理后治愈.6例患者术后出现高位肠梗阻,经对应处理后缓解.8例患者发生贮袋炎,经饮食调节或抗生素治疗后缓解.2例患者发生性功能障碍.所有患者获得随访,随访时间1～25年.术后贮袋肛门功能不断改善,术后3个月24 h和夜间排便次数、Bristol粪便分类和Kirwan分级分别为(6.5±2.8)次,(2.9±1.5)次,Ⅳ类86例、Ⅴ类89例、Ⅵ类16例,Ⅰ级160例、Ⅱ级19例、Ⅲ级12例;术后12个月分别为(3.7±1.4)次,(1.3±0.5)次,Ⅳ类107例、Ⅴ类76例、Ⅵ类8例,Ⅰ级177、Ⅱ级8例、Ⅲ级6例,两者比较,差异有统计学意义(=12.36,3.98,x2=7.76,29.27,P＜0.05).克利夫兰生命质量表评分:术前为(0.37±0.19)分,术后3个月为(0.67±0.16)分,术后12个月为(0.82±0.13)分,3者比较,差异有统计学意义(F=6.011,P＜0.05).术后3个月与术前和术后12个月比较,差异有统计学意义(t=16.69,10.06,P＜0.05);术后12个月与术前比较,差异有统计学意义(t=27.01,P＜0.05).结论 HIPAA适用于溃疡性结肠炎的外科治疗,术后贮袋肛门功能良好,可提高患者生命质量,具有较高的临床价值.
目的 評價全結直腸切除迴腸貯袋肛管手縫吻閤術(HIPAA)治療潰瘍性結腸炎的臨床價值.方法 迴顧性分析1989年1月至2013年12月天津醫科大學總醫院收治的191例潰瘍性結腸炎患者的臨床資料,採用開腹和腹腔鏡輔助手術行HIPAA.末次手術後3箇月和12箇月進行問捲調查,依據24h和夜間排便次數、Bristol糞便分類錶和Kirwan分級評價貯袋肛門功能.依據剋利伕蘭生命質量錶評價生命質量;依據貯袋炎活動指數診斷貯袋炎.隨訪時間截至2014年4月.獨立樣本比較採用t檢驗,多組比較採用方差分析,兩兩比較採用LSD-t檢驗,計數資料比較採用x2檢驗.結果 191例患者中有180例行開腹手術,11例行腹腔鏡手術.175例行二期手術,9例行一期手術,7例行三期手術.181例採用J型貯袋,9例採用H型貯袋,1例採用W型貯袋.患者無圍手術期死亡,術後早期8例患者腹腔感染,7例切口感染,應用抗生素後治愈.術後1～2週髮生貯袋吻閤口齣血4例,吻閤口漏4例,給予止血處理後治愈.6例患者術後齣現高位腸梗阻,經對應處理後緩解.8例患者髮生貯袋炎,經飲食調節或抗生素治療後緩解.2例患者髮生性功能障礙.所有患者穫得隨訪,隨訪時間1～25年.術後貯袋肛門功能不斷改善,術後3箇月24 h和夜間排便次數、Bristol糞便分類和Kirwan分級分彆為(6.5±2.8)次,(2.9±1.5)次,Ⅳ類86例、Ⅴ類89例、Ⅵ類16例,Ⅰ級160例、Ⅱ級19例、Ⅲ級12例;術後12箇月分彆為(3.7±1.4)次,(1.3±0.5)次,Ⅳ類107例、Ⅴ類76例、Ⅵ類8例,Ⅰ級177、Ⅱ級8例、Ⅲ級6例,兩者比較,差異有統計學意義(=12.36,3.98,x2=7.76,29.27,P＜0.05).剋利伕蘭生命質量錶評分:術前為(0.37±0.19)分,術後3箇月為(0.67±0.16)分,術後12箇月為(0.82±0.13)分,3者比較,差異有統計學意義(F=6.011,P＜0.05).術後3箇月與術前和術後12箇月比較,差異有統計學意義(t=16.69,10.06,P＜0.05);術後12箇月與術前比較,差異有統計學意義(t=27.01,P＜0.05).結論 HIPAA適用于潰瘍性結腸炎的外科治療,術後貯袋肛門功能良好,可提高患者生命質量,具有較高的臨床價值.
목적 평개전결직장절제회장저대항관수봉문합술(HIPAA)치료궤양성결장염적림상개치.방법 회고성분석1989년1월지2013년12월천진의과대학총의원수치적191례궤양성결장염환자적림상자료,채용개복화복강경보조수술행HIPAA.말차수술후3개월화12개월진행문권조사,의거24h화야간배편차수、Bristol분편분류표화Kirwan분급평개저대항문공능.의거극리부란생명질량표평개생명질량;의거저대염활동지수진단저대염.수방시간절지2014년4월.독립양본비교채용t검험,다조비교채용방차분석,량량비교채용LSD-t검험,계수자료비교채용x2검험.결과 191례환자중유180례행개복수술,11례행복강경수술.175례행이기수술,9례행일기수술,7례행삼기수술.181례채용J형저대,9례채용H형저대,1례채용W형저대.환자무위수술기사망,술후조기8례환자복강감염,7례절구감염,응용항생소후치유.술후1～2주발생저대문합구출혈4례,문합구루4례,급여지혈처리후치유.6례환자술후출현고위장경조,경대응처리후완해.8례환자발생저대염,경음식조절혹항생소치료후완해.2례환자발생성공능장애.소유환자획득수방,수방시간1～25년.술후저대항문공능불단개선,술후3개월24 h화야간배편차수、Bristol분편분류화Kirwan분급분별위(6.5±2.8)차,(2.9±1.5)차,Ⅳ류86례、Ⅴ류89례、Ⅵ류16례,Ⅰ급160례、Ⅱ급19례、Ⅲ급12례;술후12개월분별위(3.7±1.4)차,(1.3±0.5)차,Ⅳ류107례、Ⅴ류76례、Ⅵ류8례,Ⅰ급177、Ⅱ급8례、Ⅲ급6례,량자비교,차이유통계학의의(=12.36,3.98,x2=7.76,29.27,P＜0.05).극리부란생명질량표평분:술전위(0.37±0.19)분,술후3개월위(0.67±0.16)분,술후12개월위(0.82±0.13)분,3자비교,차이유통계학의의(F=6.011,P＜0.05).술후3개월여술전화술후12개월비교,차이유통계학의의(t=16.69,10.06,P＜0.05);술후12개월여술전비교,차이유통계학의의(t=27.01,P＜0.05).결론 HIPAA괄용우궤양성결장염적외과치료,술후저대항문공능량호,가제고환자생명질량,구유교고적림상개치.
Objective To investigate the clinical value of hand-sewn ileal pouch anal anastomosis (HIPAA) for the treatment of ulcerative colitis.Methods The clinical data of 191 patients with ulcerative colitis who were admitted to the General Hospital of Tianjin Medical University from January 1989 to December 2013 were retrospectively analyzed.All the patients received proctocolectomy and open or laparoscopic HIPAA.Patients were followed up by questionnaire at postoperative month 3 and 12.The function of pouch was evaluated according to the defecation frequency per 24 hours and per night,Bristol scale stool form and Kirwan classification.The quality of life was assessed according to the Cleveland global quality of life (CGQL).Patients were followed up till April 2014.The independent samples were compared by t test,and data from multiple groups were compared by analysis of variance,pairwise comparison was done by LSD-t test,and the count data were analyzed using the chi-square test.Results Of the 191 patients,180 received open surgery and 11 received laparoscopic surgery.Nine patients were treated by one-stage surgery,175 by two-stage surgery and 7 by three-stage surgery.The pouches of 181 patients were J shape,9 were H shape and 1 was W shape.No patient died perioperatively.Eight patients had abdominal infection and 7 had incisional infection at early period after the operation,and they were cured by antibiotics.Four patients had pouch anastomotic bleeding and 4 had anastomotic leakage at postoperative week 1-2,and they were cured by local hemostasis or titanium clipping.Six patients had high intestinal obstruction,and they were alleviated by symptomatic treatment.Eight patients had inflammation of pouch,and they were alleviated by diet adjustment or antibiotics treatment.Two patients had sexual dysfunction.All the patients were followed up for 1-25 years.The function of the pouch was improved gradually.At postoperative month 12,the defecation frequencies were (3.7 ± 1.4)/24 hours and (1.3 ±0.5)/night,and the number of patients with type Ⅳ (Bristol classification),type Ⅴ,type Ⅵ and in grade Ⅰ (Kirwan classification),grade Ⅱ,grade Ⅲ were 107,76,8 and 177,8,6,respectively,which were significantly improved when compared with (6.5 ±2.8)/24 hours,(2.9 ± 1.5)/night,86,89,16 and 160,19,12 at postoperative month 3 (t =12.36,3.98,x2=7.76,29.27,P＜ 0.05).The CGQL indexes before operation and at postoperative month 3 and 12 were 0.37 ±0.19,0.67 ±0.16 and 0.82 ±0.13,respectively,with significant differences (F =6.011,P ＜0.05).There were significant differences between the CGQL indexes before operation and at postoperative 12 and 3 months (t =16.69,10.06,P ＜ 0.05).A significant difference was also observed between the CGQL indexes before operation and at postoperative 12 months (t =27.01,P ＜ 0.05).Conclusions HIPAA is suitable for the surgical treatment of ulcerative colitis.The function of the pouch is good and the quality of life is improved.
