摘要
目的比较溃疡性结肠炎(UC)行二期或三期全结直肠切除(TPC)联合回肠储袋肛管吻合术(IPAA)后的近期并发症及远期临床结局。方法回顾性分析2014—2020年南京大学医学院附属金陵医院普通外科炎症性肠病治疗中心行TPC+IPAA的188例病人临床资料,比较术后近期(二期手术的第一期及三期手术的第一、二期)并发症及远期并发症。采用单因素分析、倾向值匹配分析和问卷调查观察病人术后并发症和远期生活质量。结果 188例病人中,136例(72.3%)病人实施二期IPAA,52例(27.7%)病人实施三期IPAA。三期手术的病人体重指数(BMI)、术前血红蛋白、术前白蛋白水平低于二期手术病人,而C-反应蛋白(CRP)、白细胞介素(IL)-6、降钙素原增高(P均<0.05)。二期手术病人的Clavien-DindoⅢa级以上近期并发症(储袋出血、切口感染、腹盆腔感染、肠梗阻、储袋相关瘘)、远期并发症(储袋炎、肠梗阻、储袋瘘、吻合口狭窄)发生率与三期手术病人比较差异无统计学意义(P均>0.05)。二期手术病人的24 h排便次数、夜间排便次数、生活质量评分、健康状况评分与三期手术病人差异无统计学意义(P均>0.05)。采用倾向值匹配分析后,两组术后近远期结局差异无统计学意义(P均>0.05)。二期手术病人的住院费用低于三期手术病人(P<0.05)。结论 IPAA是治疗UC的安全有效的手术方式,二期和三期手术的术后并发症无明显差异。
Objective To compare the perioperative and long-term complications and functional outcomes between two-and three stage total proctocolectomy plus ileal pouch anal anastomosis(IPAA) for patients with ulcerative colitis(UC).Methods Clinical data of 188 UC patients corresponded with inclusion criteria and underwent IPAA surgery in Inflammatory Bowel Disease Treatment Center,Department of General Surgery,Affiliated Jinling Hospital,Medical School Nanjing University from 2014 to 2020 were retrospectively analyzed.The perioperative(the first of two-stage and the first/second of three-stage) and long-term complications between two-and three-stage IPAA were compared.Perioperative complications and late outcomes were analyzed by univariate analysis,propensity score matching(PSM)and questionnaire.Results Among the 188 patients,136 patients(72.3%) underwent 2-stage and 52(27.7%)underwent 3-stage procedures.The body mass index(BMI),preoperative hemoglobin,and serum albumin of patients undergoing 3-stage procedures were significantly lower,while C-reactive protein(CRP),interleukin-6(IL-6),and procalcitonin were significantly higher compared to 2-stage surgery,with statistical differences(all P<0.05).There was no significant difference in the proportion of short-term major complications(pouch bleeding,incision infection abdominal and pelvic infection,intestinal obstruction,pouch-associated fistulas,C-D graded≥Ⅲ a) and long-term complications(pouchitis,intestinal obstruction,pouch fistula,anastomotic stenosis) between patients who underwent 2-or 3-stage IPAA(P> 0.05).There was no significant difference in the frequency of 24-hour defecation,overnight defecation,quality of life,and health status score among patients between the 2-and 3-stage group(P> 0.05).The hospitalization cost of 2-stage is significantly lower than that of 3-stage surgery(P<0.05).Conclusion IPAA is an effective and safe surgical treatment for patients with ulcerative colitis,and there is no significant difference in postoperative complications between th
作者
余泽谦
张腾辉
赵磊
朱峰
郭振
朱维铭
龚剑峰
YU Ze-qian;ZHANG Teng-hui;ZHAO Lei(Department of General Surgery,Afjllk ated Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2021年第8期913-918,共6页
Chinese Journal of Practical Surgery
基金
国家自然科学基金面上项目(No.81970469)。
关键词
溃疡性结肠炎
回肠储袋肛管吻合术
术后并发症
ulcerative colitis
ileal pouch-anal anastomosis
postoperative complications
