腹腔镜辅助全结直肠切除、回肠J型储袋与肛管吻合治疗家族性腺瘤性息肉病
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摘要
目的探讨腹腔镜辅助全结直肠切除、回肠J型储袋与肛管吻合治疗家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)的疗效。方法 2013年1月～2017年12月对15例FAP施行全结直肠切除、回肠J型储袋与肛管吻合术。先行腔镜下全结直肠的游离,离断直肠,然后将回肠断端构建J形储袋,经肛门放置直线管状吻合器,拉下回肠,完成贮袋肛管吻合。结果 15例均顺利完成腹腔镜辅助下全结直肠切除术、回肠J型储袋与肛管吻合。手术时间(112. 4±32. 3) min,术后住院时间(9. 9±2. 5) d。术后病理4例息肉恶变。术后1例出现盆腔感染,穿刺引流后好转。15例平均随访28个月(3～60个月),术后随访1年时,大便次数(3. 3±1. 4)次/d,基本成形,无肿瘤复发及死亡。结论腹腔镜辅助全结直肠切除、回肠J型储袋与肛管吻合是治疗FAP的有效手术方式。
Objective To investigate the efficacy of laparoscopic assisted total colorectal resection and ileal J-pouch anal anastomosis in the treatment of familial adenomatous polyposis( FAP). Methods The clinical and follow-up data of 15 patients with FAP who underwent total colorectal resection and ileal J-pouch anal anastomosis in our hospital from January 2013 to December 2017 were analyzed retrospectively. During the operation,total colorectal dissection was performed by using laparoscopy. Then the J-shaped storage bag was constructed at the end of the ileum,and a straight tubular anastomosis device was placed through the anus to complete pouch anal anastomosis. Results All the 15 patients received successful laparoscopic assisted total colorectal resection and ileal Jpouch anal anastomosis. The operation time was( 112. 4 ± 32. 3) min,and the postoperative hospital stay was( 9. 9 ± 2. 5) d.Pathological results showed 4 cases of malignant lesions. Postoperative pelvic infection occurred in 1 case,which was relieved after puncture and drainage. The average follow-up time was 28 months( range,3-60 months). After one year of follow-up,the average number of stools was( 3. 3 ± 1. 4) times/d,which were basically formed. No recurrence or death was seen. Conclusion Laparoscopic assisted total colorectal resection and ileal J-pouch anal anastomosis is an effective treatment for FAP.
Objective To investigate the efficacy of laparoscopic assisted total colorectal resection and ileal J-pouch anal anastomosis in the treatment of familial adenomatous polyposis( FAP). Methods The clinical and follow-up data of 15 patients with FAP who underwent total colorectal resection and ileal J-pouch anal anastomosis in our hospital from January 2013 to December 2017 were analyzed retrospectively. During the operation,total colorectal dissection was performed by using laparoscopy. Then the J-shaped storage bag was constructed at the end of the ileum,and a straight tubular anastomosis device was placed through the anus to complete pouch anal anastomosis. Results All the 15 patients received successful laparoscopic assisted total colorectal resection and ileal Jpouch anal anastomosis. The operation time was( 112. 4 ± 32. 3) min,and the postoperative hospital stay was( 9. 9 ± 2. 5) d.Pathological results showed 4 cases of malignant lesions. Postoperative pelvic infection occurred in 1 case,which was relieved after puncture and drainage. The average follow-up time was 28 months( range,3-60 months). After one year of follow-up,the average number of stools was( 3. 3 ± 1. 4) times/d,which were basically formed. No recurrence or death was seen. Conclusion Laparoscopic assisted total colorectal resection and ileal J-pouch anal anastomosis is an effective treatment for FAP.
引文
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2 Vasen HF,Moslein G,Alonso A,et al.Guidelines for the clinical management of familial adenomatous polyposis(FAP).Gut,2008,57(5):704-713.
3中国抗癌协会大肠癌专业委员会遗传学组.遗传性结直肠癌临床诊治和家系管理.中华肿瘤杂志,2018,40(1):64-77.
4 Aihara H,Kumar N,Thompson CC.Diagnosis,surveillance,and treatment strategies for familial adenomatous polyposis:rationale and update.Eur J Gastroenterol Hepatol,2014,26(3):255-262.
5 Kastrinos F,Syngal S.Inherited colorectal cancer syndromes.Cancer J,2011,17(6):405-415.
6丁召,吴云华,秦前波,等.回肠D型储袋在溃疡性结肠炎和家族性腺瘤性息肉病手术治疗中的应用.中华胃肠外科杂志,2015,18(12):1231-1234.
7 Noh GT,Han J,Cho MS,et al.Factors affecting pouch-related outcomes after restorative proctocolectomy.PLo S One,2017,12(10):e0186596.
8张昭,王丹,徐彬,等.腹腔镜辅助全结直肠切除术治疗家族性腺瘤性息肉病.中华普通外科杂志,2015,30(9):711-714.
9耿岩,胡彦锋,余江,等.中间入路法腹腔镜辅助全结直肠切除的临床应用.中华胃肠外科杂志,2013,16(1):32-35.
10吴凯,喻春钊.低位直肠癌及其腹腔镜手术特殊性与预防性造口的选择.中国微创外科杂志,2017,17(9):832-835.
2 Vasen HF,Moslein G,Alonso A,et al.Guidelines for the clinical management of familial adenomatous polyposis(FAP).Gut,2008,57(5):704-713.
3中国抗癌协会大肠癌专业委员会遗传学组.遗传性结直肠癌临床诊治和家系管理.中华肿瘤杂志,2018,40(1):64-77.
4 Aihara H,Kumar N,Thompson CC.Diagnosis,surveillance,and treatment strategies for familial adenomatous polyposis:rationale and update.Eur J Gastroenterol Hepatol,2014,26(3):255-262.
5 Kastrinos F,Syngal S.Inherited colorectal cancer syndromes.Cancer J,2011,17(6):405-415.
6丁召,吴云华,秦前波,等.回肠D型储袋在溃疡性结肠炎和家族性腺瘤性息肉病手术治疗中的应用.中华胃肠外科杂志,2015,18(12):1231-1234.
7 Noh GT,Han J,Cho MS,et al.Factors affecting pouch-related outcomes after restorative proctocolectomy.PLo S One,2017,12(10):e0186596.
8张昭,王丹,徐彬,等.腹腔镜辅助全结直肠切除术治疗家族性腺瘤性息肉病.中华普通外科杂志,2015,30(9):711-714.
9耿岩,胡彦锋,余江,等.中间入路法腹腔镜辅助全结直肠切除的临床应用.中华胃肠外科杂志,2013,16(1):32-35.
10吴凯,喻春钊.低位直肠癌及其腹腔镜手术特殊性与预防性造口的选择.中国微创外科杂志,2017,17(9):832-835.