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복원성 직장결장 절제술 및 회장항문 문합술의 임상적 경험

Clinical Experience of Restorative Protocolectomy and Ileal Pouch-Anal Anastomosis

대한대장항문학회지 1996년 12권 1호 p.89 ~ 98
정갑중 ( Jung Ghap-Joong ) - 동아대학교 의과대학 외과학교실

정일권 ( Jung Il-Kwon ) - 동아대학교 의과대학 일반외과학교실
김형호 ( Kim Hyung-Ho ) - 동아대학교 의과대학 외과학교실
최홍조 ( Choi Hong-Jo ) - 동아대학교 의과대학 외과학교실
김영훈 ( Kim Young-Hoon ) - 동아대학교 의과대학 외과학교실
조세헌 ( Joh Se-Heon ) - 동아대학교 의과대학 외과학교실
김상순 ( Kim Sang-Sun ) - 동아대학교 의과대학 외과학교실

Abstract


Between November 1990 and May 1995, 7 patients underwent restorative proctocolectomy for the treatment of chronic ulcerative colitis(n=5) and of familial adenomatous polyposis(n=2) at the Dong-A Medical Center. J-pouch was made in 5
cases and S-pouch in 1 case. In one case no pouch was made. The aim of this study was to review the postoperative course retrospectively in terms of the management of early and late complications and to asess long-term stool frequency (1∼7, average=4.4 except for 1 case that was 10 per day). Early major complication was anastomotic dehescence in 2 cases(28.6% ), one of whom died of pelvic sepsis (mortality rate: 14.3%). Pouchitis(n= 1), anovaginal fistula(n= 1) and anastomotic stricture(n= 1) developed in late postoperative period. All of the early and late complications except one case were managed successfully by adequate drainage and local irrigation, or anal dilatiation. Stool frequency was gradually decreased in number postoperatively(2∼4/day by 1 year) espeacially, in 1 case with 4 years follow-up(1 ∼2/day).
It is concluded that major early and late complications including anastomotic dehescence and anovaginal fistula can be managed successfully by conservative treatment and long-term stool frequency is clinically acceptable.

키워드

Ileal Pouch-Anal Anastomosis;Familial Adenomatous Polyposis(FAP);Ulcerative Colitis
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