궤양성 대장염 환자에서 시행되는 회장낭 수술에 대한 이견 (Controversies in Pouch Surgery for Ulcerative Colitis)

서지정보

· 발행기관 : 대한대장항문학회
· 수록지 정보 : Annals of Coloproctolgy / 25권 / 3호 / 207 ~ 211페이지
· 저자명 : 유창식

초록

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.

영어초록

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.

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