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전대장절제술 및 회장낭항문문합술에서 우회성 회장루의 필요성

The Significance of Diverting Ileostomy during Restorative Proctocolectomy

대한대장항문학회지 2002년 18권 6호 p.386 ~ 389
홍동현 ( Hong Dong-Hyun ) - 울산대학교 의과대학 외과학교실

유창식 ( Yu Chang-Sik ) - 울산대학교 의과대학 외과학교실
남궁환 ( Namgung Hwan ) - 울산대학교 의과대학 외과학교실
조영규 ( Cho Young-Kyu ) - 울산대학교 의과대학 외과학교실
김희철 ( Kim Hee-Cheol ) - 울산대학교 의과대학 외과학교실
김진천 ( Kim Jin-Cheon ) - 울산대학교 의과대학 외과학교실

Abstract


Purpose: Restorative proctocolectomy (RP) is a standard surgery in patients with ulcerative colitis and familial adenomatous polyposis. Usually, diverting ileostomy is performed to protect an ileoanal anastomosis with RP. However, there are many controversies whether diverting ileostomy might urgently be needed. This study was performed to compare postoperative complications after RP with or without diverting ileostomy.

Methods: Between July 1994 and June 2001, 77 (M:F= 45:32) patients underwent RP. The indication criteria for diverting ileostomy included tension at the anastomosis, positive leakage test, compromised blood flow in the ileal pouch,
long-term and high-dose steroid use, and severe rectal inflammation in ulcerative colitis patients.

Results: Histopathologic diagnoses revealed 45 ulcerative colitis, 23 familial adenomatous polyposis, 5 rectal cancer, and 4 hereditary nonpolyposis colorectal cancer. Diverting ileostomies were performed in 40 patients (51.9%) and closed approximately 4 months later. Fourty eight complications were present in 32 patients. There was no perioperative death. There was no difference in perioperative outcome, morbidity or functional status between patients with and without ileostomy. However, in ulcerative colitis patients, anastomosis leakage was more frequent in patients without ileostomy.

Conclusions: Restorative proctocolectomy can be safely performed without diverting ileostomy in most cases of RP. However, diverting ileostomy may reduce anastomosis leakage in patients with ulcerative colitis.

키워드

전대장절제술 및 회장낭항문문합술;우회성 회장루;궤양성대장염;문합부 누출
Restorative proctocolectomy;Diverting ileostomy;Ulcerative colitis;Anastomosis leakage
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