家族性腺瘤性息肉病患者结直肠癌变的外科预防_临床医学论文.docVIP

家族性腺瘤性息肉病患者结直肠癌变的外科预防_临床医学论文 家族性腺瘤性息肉病患者结直肠癌变的外科预防_临床医学论文 作者：周欣 周建农 尚俊清 许发培 【摘要】 目的 探讨家族性腺瘤性息肉病（FAP）患者结直肠癌变外科预防的手术时机和术式选择。方法 回顾性分析我院近年来连续诊治的43例FAP患者结直肠癌的发病状况及预防性手术治疗的疗效。结果 未经手术干预的FAP患者，20岁、25岁、30岁、35岁、40岁、45岁、50岁时的累积结直肠癌变风险分别约为0、10.4%、25.3%、32.4%、63.0%、76.9%、86.2%；发生结直肠癌变的病例中有84.6%发生直肠癌变。11例患者在我院接受了预防性手术治疗，无手术死亡，3例全结直肠切除、回肠J肛管手工吻合术患者术后并发吻合口瘘。1例结肠次全切除的患者于术后13年直肠癌变。3例回肠J肛管吻合患者无肛门失禁，每日排便4～6次。结论 FAP患者预防性手术治疗时机应在20岁之前，最迟不超过25岁，全结直肠切除、回肠J肛管吻合器吻合术预防结直肠癌变安全有效，适合作为预防性手术的首选术式。 【关键词】 家族性腺瘤性息肉病；手术治疗；癌变防治 Riskl surgery for familial adenomatous polyposis [Abstract] Objective To investigate the optimal timing and prophylactic surgical procedure for patients with familial adenomatous polyposis (FAP). Methods Colorectal cancer risk and the outcome of prophylactic colorectal surgery in 43 FAP patients consecutively diagnosed and/or treated in our hospital were retrospectively analyzed. Results Without surgical intervention, the cumulative colorectal cancer risk in FAP patients at the age of 20, 25, 30, 35, 40, 45,and 50 was estimated at 0, 10.4%, 25.3%, 32.4%, 63.0%, 76.9%, and 86.2% respectively. Rectal cancer occurred in about 84.6% of FAP patients who were affected by colorectal cancer. Prophylactic surgery was performed in our hospital to 11 patients, out of whom, 2 received subtotal colectomy, 3 total proctocolectomy and ileal endstomosis, 4 total proctocolectomy and handsewed ileal Jpouchanal anastomosis, and 2 total proctocolectomy and stapled ileal Jpouchanal anastomosis. There was no surgical mortality. Three out of 4 patients encountered anastomotic fistula after total proctocolectomy and handsewed ileal Jpouchanal anastomosis. Rectal cancer occurred in 1 patient 13 years after subtotal colectomy. In 3 patients who finally preserved their ileal Jpouchanal anastomosis, there was no anal incontinence, and the bowel frequency was about 46 times per day. Conclusion The prophylactic surgery for FAP should be timed before 20 years of age, and be postponded no mor