전 대장 직장 절제 및 J형 회장낭 항문 문합술 기능적 평가
Restorative Proctocolectomy Operative Safety and Functional Outcomes
김남규, 손승국, 박준성, 이강영, 민진식, 박재균,
소속 상세정보
김남규 ( Kim Nam-Kyu )
연세대학교 의과대학 외과학교실
손승국 ( Sohn Seung-Kook )
연세대학교 의과대학 외과학교실
박준성 ( Park Joon-Seong )
연세대학교 의과대학 외과학교실
이강영 ( Rhee Kang-Young )
연세대학교 의과대학 외과학교실
민진식 ( Min Jin-Sik )
연세대학교 의과대학 외과학교실
박재균 ( Park Jea-Kun )
연세대학교 의과대학 외과학교실
KMID : 0371320010600040438
Abstract
Purpose: The restorative proctocolectomy has been accepted as the operation of choice for chronic ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess the operative safety and the functional outcome after a total proctocolectomy and ileal-pouch anal anastomosis.
Methods: The medical records of 16 patients who had undergone a total proctocolectomy and ileal-pouch anal anastomosis for ulcerative colitis (n=9) and familial adenomatous polyposis (n=7) from January 1996 to December 1999 were reviewed. The mean length of follow-up was 19.9 months, and we evaluated functional outcome using a prepared questionnaire.
Results: A hand-sewn anastomosis with diverting ileostomy was performed in 9 patients, and a double stapled anastomosis was done in 7 patients. Postoperative complications occurred in 8 cases (50%): intestinal obstructions in 4 patients and anastomosis related complications in 4 patients, i.e. stenosis (n=2), leak (n=1) and perianal abscess (n=1). The defecation frequency and the, day and night continence were improved in the first period (one year after surgery) compared to the second period (3 months after surgery). The need for anti-diarrheal medication, and for the use of a pad was also decreased in the second period compared to the first period. Postoperative urinary function was satisfactory in 13 of 14 patients. Postoperative sexual function was assessed in 8 patients (5 males, 3 females) and showed in good erection (5/5), ejaculation (5/5), and satisfactory sexual life (8/8).
Conclusion: Satisfactory functional outcomes regarding the frequency of bowel movement and fecal incontinence and operative safety can be achieved after a restorative proctocolectomy for chronic ulcerative colitis and familial adenomatous polyposis.
키워드
전 대장 직장 절제술;J형 회장낭;기능적 평가
Restorative proctocolectomy;Ileal J pouch;Functional outcomes
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