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궤양성 대장염 환자에서 시행되는 회장낭 수술에 대한 이견

Controversies in Pouch Surgery for Ulcerative Colitis

대한대장항문학회지 2009년 25권 3호 p.207 ~ 211
유창식 ( Yu Chang-Sik ) - 울산대학교 의과대학 외과학교실

Abstract


Restorative proctocolectomy (RPC) has become a standard procedure over 30 yr in patients with ulcerative colitis and familial adenomatous polyposis. However, there are several controversies in surgical method and strategy. From oncological point of view, mucosal proctectomy and hand-sewn ileal pouch anal anastomosis has advantage because of relatively complete removal of columnar epithelium. However, long-term follow-up results after stapled anastomosis revealed extremely low incidence of dysplasia in the anal transitional zone (ATZ). Furthermore, recent publication of 26 cancer occurrence after RPC showed more prevalence in mucosectomy group. Risk factors of dysplasia after RPC are supervening cancer or dysplasia on the proximal colon, long duration of symptom, and history of primary sclerosing cholangitis. Preservation of ATZ by stapled anastomosis may have functional superiority, which is supported by some manometric and functional studies. However, two randomized controlled trials showed no difference between the groups. Although there are some surgeons who advocate one stage RPC, majority of centers prefer two stage RPC with ileostomy. According to meta-analysis one stage RPC revealed 2-3 times frequent anastomotic leakage or pelvic sepsis. Five to ten percent of ulcerative colitis has some pathologic characteristics of Crohn’s disease, which is classified as indeterminate colitis (IC). Long-term results of RPC in patients with IC revealed similar results with ulcerative colitis and superior to Crohn’s disease. So RPC may be justified in patients with IC. Conclusively, RPC should be tailored according to clinicopathologic details and operative findings.

키워드

궤양성대장염;점막절제술;자동봉합기문합;회장루;불확정대장염
Ulcerative colitis;Mucosectomy;Stapled anastomosis;Ileostomy;Indeterminate colitis
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