전직결장절제술 및 회장낭-항문 문합술의 술 후 합병증 및 배변기능에 대한 고찰 12예
The Clinical Results of a Total Proctocolectomy with an Ileal Pouch-Anal Anastomosis: 12 Cases
이경춘, 이승현, 안병권, 백승언,
소속 상세정보
이경춘 ( Lee Kyung-Chun )
고신대학교 복음병원 외과학교실
이승현 ( Lee Seung-Hyun )
고신대학교 복음병원 외과학교실
안병권 ( Ahn Byung-Kwon )
고신대학교 복음병원 외과학교실
백승언 ( Baek Sung-Uhn )
고신대학교 복음병원 외과학교실
KMID : 0356720030190010006
Abstract
Purpose:A restorative proctocolectomy has been accepted as the operation of choice for ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess the postoperative complications and functional outcomes following a total proctocolectomy with a J ileal pouch-anal anastomosis.
Methods:The medical records of 12 patients who had undergone a total proctocolectomy, with a J ileal pouch-anal anastomosis, between January 1997 and June 2002, were retrospectively reviewed according to sex, age, underlying disease and postoperative complications. We evaluated the functional outcomes using medical record reviews and patients and telephone interviews.
Results:Total proctocolectomy, with a J ileal pouch-anal anastomosis, were done for ulcerative colitis (n=2) and familial adenomatous polyposis (n=10). A diverting ileostomy was performed in 8 patients. Postoperative complications occurred in 7 patients (58%), intestinal obstructions in 4 and complications related with anastomosis in 3, i.e. J ileal pouch leakage (n=2) and ileal pouch-vaginal fistula (n=1). Re-operations, due to postoperative complications, were performed in 4 patients, i.e. small bowel segmental resection (n=1), adhesiolysis (n=1), diverting ileostomy (n=1) and ileal pouch resection & reconstruction (n=1). The daily median defecation frequencies were 7.7 (range 4∼20) a month after the operation, 5.4 (3∼12) at 2∼3 months, 4.5 (3∼7) at 6 months and 4.1 (3∼5) at 12 months, following the operation. Two patients had gas incontinence, 1 had fluid incontinence, 4 had night soiling and 3 needed pads, but these incontinences, the need for anti-diarrhea medication and the use of pads, all improved within 6 months of the operation. Fluid incontinence and the use of pads improved within 3 months of the operation, gas incontinence and night soiling improved within 6 months of the operation. The mean length of follow-up was 30.6 months.
Conclusions:The postoperative complication rate was 58%. Thirty-three percent of patients had fecal incontinence, but all these improved within 6 months. The long-term functional outcomes, after a total proctocolectomy with J ileal pouch-anal anastomosis, were satisfactory, and the postoperative complications acceptable. The ostoperative complication rates were no different between the protective diverting ileostomy and non-ileostomy groups.
키워드
전직결장절제술;J형 회장낭-항문 문합술;술 후 합병증;기능적 평가
Total proctocolectomy;Ileal pouch anal anastomosis;Postoperative complication;Functional outcomes
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