가족성 선종성 용종증과 궤양성 대장염에서 보존성 전대장절제술 및 회장낭-항문문합술 후 치료성적 비교
Comparison of the Result of Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis in Familial Adenomatous Polyposis and Ulcerative Colitis
박선진, 홍성화, 오수명, 윤충, 이길연, 이기형, 고석환,
소속 상세정보
박선진 ( Park Sun-Jin )
경희대학교 의과대학 외과학교실
홍성화 ( Hong Sung-Wha )
경희대학교 의과대학 외과학교실
오수명 ( Oh Soo-Myung )
경희대학교 의과대학 외과학교실
윤충 ( Yoon Choong )
경희대학교 의과대학 외과학교실
이길연 ( Lee Kil-Yeon )
경희대학교 의과대학 외과학교실
이기형 ( Lee Kee-Hyung )
경희대학교 의과대학 외과학교실
고석환 ( Koh Suck-Hwan )
경희대학교 의과대학 외과학교실
KMID : 0356720010170040171
Abstract
Purpose: The aim of this study was to compare the early postoperative results and the long-term outcome of restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) in familial adenomatous polyposis (FAP) and ulcerative colitis (UC).
Methods: Thirty patients that underwent IPAA for either FAP (14 patients) or UC (16 patients) at Kyung-Hee University Hospital between January 1987 and December 1999 were studied retrospectively. Either handsewn or stapled anastomosis technique was used in IPAA. Most patients (12 patients in FAP, 16 patients in UC) had a two-stage operation with temporary diverting loop ileostomy and two patients with FAP had a one-stage operation without temporary ileostomy.
Results: One patient in the UC group died from sepsis after operation (n=16, 6.25%), but no patients in the FAP group died. Overall operative complications appeared in two patients (14.3%) and four patients (25%) with FAP and UC, respectively. At follow-up (mean, 47.3 months), pouchitis was developed in four patients with UC, but no patients with FAP. The mean daytime stool frequency was 4.5 stools per day in FAP patients and 5.8 stools per day in UC patients (P=0.031), but night-time stool frequency was similar between two groups (1.2 and 1.4 in FAP and UC, respectively; P＞0.05). Daytime fecal incontinence was noticed in two patients (14.3%) with FAP and four patients (26.7%) with UC. Night-time fecal incontinence was noticed in three patients (21.4%) with FAP and six patients (40.0%) with UC.
Conclusion: FAP patients tolerated the operation better and had less long-term disability than did UC patients. This suggested that the long-term outcome of IPAA procedure may depend on the primary disease rather than the procedure itself.
키워드
보존성 전대장절제술;회장낭-항문문합술;가족성 선종성 용종증;궤양성 대장염
Restorative proctocolectomy;Ileal pouch-anal anastomosis (IPAA);Familial adenomatous polyposis (FAP);Ulcerative colitis (UC)
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