摘要目的 探讨全结直肠切除(TPC)回肠储袋肛管吻合术(IPAA)治疗溃疡性结肠炎(UC)及家族性腺瘤性息肉病(FAP)的近期并发症发生及转归情况.方法 回顾性收集2006年1月至2016年3月92例接受IPAA手术治疗的UC和FAP患者的临床资料,观察患者IPAA术后3月内的近期并发症情况.结果 IPAA术后发生近期并发症共13例(14.1％),盆腔感染或脓肿形成3例(3.3％),给予抗感染、腹盆腔引流管低压冲洗、关闭回肠双腔造口远端等治疗痊愈;术后近期出血3例(3.3％),储袋肛管吻合口出血1例,储袋侧侧吻合线出血2例,予冰肾上腺素、凝血酶溶液等保留灌肠后2例出血停止,1例内镜下取出钛钉后出血停止;术后1月内吻合口狭窄2例(2.2％),通过早期扩肛治愈;储袋相关瘘5例(5.4％),其中,储袋残端瘘2例(2.2％),吻合口阴道瘘2例(2.2％),吻合口瘘1例(1.1％),通过关闭回肠双腔造口远端、腹盆腔引流管低压冲洗、直肠阴道冲洗等综合治疗治愈.结论 TPC-IPAA术后近期并发症发生率低,以储袋相关瘘最常见,预后良好.

abstractsObjective To investigate the short-term complications and outcomes of the total proctocolectomy (TPC) and ileal pouch anal anastomosis (IPAA) in the treatment of ulcerative colitis (UC) and familial adenomatous polyposis (FAP).Methods Clinical data of 92 patients with UC or FAP undergoing total proctocolectomy and ileal pouch-anal anastomosis during January 2006 to March 2016 were collected to observe short-term complications within three months after IPAA.Results Thirteen of 92 patients (14.1％) had short-term complications after IPAA.Three patients (3.3％) were complicated with pelvic infection or abscess,who were healed after anti-infection,low pressure rinse of the pelvic cavity with drainage tube,and closure of the distal cavity.Three patients (3.3％) were hemorrhage,including 1 of pouch-anal anastomotic bleeding and 2 of the staple line side bleeding,whose bleeding was stopped after using irrigation of the pouch with adrenaline and thrombin solution for 2 patients and taking out the titanium-screw with endoscope for the other one.Two patients (2.2％) were complicated with strictures within one month and were cured by early anal dilatation.Five patients (5.4％) had pouch-related fistulas,including 2 (2.2％) of pouch-stump leak,2 (2.2％) of pouch-vaginal fistula and 1 (1.1％) of anastomotic leak,who were cured by closure of distal stoma,lower pressure rinse of pelvic cavity with drainage tube,and rectovaginal rinsing.Conclusions The morbidity of short-term complication of TPC-IPAA in the treatment of UC and FAP is low.Pouch-related fistula is the most common complication with good prognosis.