頁籤選單縮合
| 題 名 | The Endorectal Ileal J-Pouch-Anal Anastomosis Experience in CGMH=直腸內腔丁型迴腸袋肛門吻合術治療慢性潰瘍性大腸炎及家屬性大腸瘜肉症之報告 |
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| 作 者 | 陳進勛; | 書刊名 | 中華民國外科醫學會雜誌 |
| 卷 期 | 20:4 1987.07[民76.07] |
| 頁 次 | 頁305-313 |
| 分類號 | 416.245 |
| 關鍵詞 | 直腸內腔丁型迴腸袋肛門吻合術; 慢性潰瘍性大腸炎; 家屬性大腸瘜肉症; |
| 語 文 | 英文(English) |
| 中文摘要 | 慢性潰瘍性大腸炎與家屬性多發性肉症,是兩種局限於大腸黏膜之疾病。如果能在發病之早期將可有大腸黏膜切除掉,卽可免除其疾病且可避免其高比率之惡性變化。在1940-1970年代,全大腸直腸切除及迴腸人工肛門手術是其主要的外科療法者。雖然在1969年Dr. Kook改良了迴腸造瘻之做法,其發明之寇氏迴腸造瘻(koch's pouch),雖然早期報告65%之病人不需使用人工肛門袋,然總不能避免腸造瘻之存在,其他人之報告,併發症很高。 如何將所有大腸黏膜切除,而且又可免除腸造瘻之苦,乃所有大腸外科醫師追求之目標。 自1978年Dr.A. G Parks報告了8例以迴腸S狀袋接肛門成功之報告以後,全世界乃興起了以全大腸切除,存留部份肛門直腸肌肉層及迴腸袋肛門之吻合手術來治療此兩種疾病。各種不同形狀之迴腸袋亦紛紛出籠一如S形袋,J形袋,同側蠕動側吻合迴腸袋,W形袋等。 研究各種形狀之迴腸袋及其利弊發現,S形袋雖有好的容量可減少排便次數,然其不能自然排便之比率太高且因其存留之直腸肌肉套太長,致開刀時間長且併發症高,而J形袋如梅約診所(Mago clinic)改良Dr.Utsunomiya所做者,雖然免除排便之困難,然因其容量太少(約200 c.c.而已)故排便次數增多,同側蠕動之迴腸袋之功能與S形袋差不多,但照Dr.Farkalsrue之報告實在太費時且併發症亦是,而W形袋與J形袋亦屬同功能只是再創更大容積之J形袋而已。 本院有鑑於此,更以加大之J形袋而造迴腸袋肛門吻合(以40至50公分之迴腸來做迴腸袋)。從1984年至1986年1月本院共做10個此種手術其中有7個其暫時性迴腸造口已闢回,這7個病例之平均迴腸容積的300 c.c.沒有一個肛門失禁及迴腸袋leakage之病例 ,其功能尚令人滿意,謹此報告做參考。 |
| 英文摘要 | From September 1984 to January 1986, 10 patients (6 men and 4 women) with an average age of 35 years (range 26 to 53 years) received total colectomy, mucosal proctectomy, endorectum ileal J-pouch anal anastomosis at Chang Gung Memorial Hospital. Nine were cases of chronic ulcerative colitis (CUC) and one of familial polyposis colic (FPC). Eight patients underwent two-stage procedures and two patients underwent three-stage procedures. Seven patients had closure of loop ileostomy (average time for closure of loop ileostomy was tree months) and average follow up was six months (one month to one year and three months). All patients had good anal continence and could differentiate gas from stool. The average frequency of bowel movements were 9±2 for first month 6±1 for the third and 4±1 for the sixth month. The average pouch volume was 300 c.c. There was a high proportion of patients taking an antidiarrheal medication, mainly imodium. Two patients experienced mild night-soiling, and one needed to wear a pad during the night. There was no mortality in this series, no pouch leakage, nor urinary bladder or sexual dysfunction. No pouchitis was noted in this limited series, but two minor pelvic infections were cared by for Nelaton irrigation. The ideal operation for CUC and FPC would allow resection of the diseased colon and rectum while preserving voluntary defecation and anal continence, thus avoiding a permanent stoma. The total colectomy, mucosal protectomy and pouch ileal anal anastomosis just achieved these goals. Limited experience in J-pouch ileal anal anstomosis procedure is reported here. |
本系統中英文摘要資訊取自各篇刊載內容。