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首页> 外文期刊>Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland >Restorative proctocolectomy: an example of how surgery evolves in response to paradigm shifts in care
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Restorative proctocolectomy: an example of how surgery evolves in response to paradigm shifts in care

机译：恢复proctocolectomy:如何苏尔的一个例子盖瑞的发展在汽车响应的范式转换e

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Abstract Aim Surgical technique constantly evolves in response to the pressure of progress. Ileal pouch anal anastomosis (IPAA) is a good example. We analysed the effect of changes in practice on the technique of IPAA and its outcomes. Method Patients undergoing primary IPAA at this institution were divided into three groups by date of the IPAA: those operated from 1983 to 1993, from 1994 to 2004 and from 2005 to 2015. Demographics, patient comorbidity, surgical techniques, postoperative outcomes, pouch function and quality of life were analysed. Results In all, 4525 patients had a primary IPAA. With each decade, increasing numbers of surgeons were involved (decade I, 8; II, 16; III, 31), patients tended to be sicker (higher American Society of Anesthesiologists score) and three‐staged pouches became more common. After an initial popularity of the S pouch, J pouches became dominant and a mucosectomy rate of 12% was standard. The laparoscopic technique blossomed in the last decade. 90‐day postoperative morbidity by decade was 38.3% vs 50% vs 48% ( P? ? 0.0001), but late morbidity decreased from 74.2% through 67.1% to 30% ( P? ? 0.0001). Functional results improved, but quality of life scores did not. Pouch survival rate at 10?years was maintained (94% vs 95.2% vs 95.2%; P? = ? 0.06). Conclusion IPAA is still evolving. Despite new generations of surgeons, a more accurate diagnosis, appropriate staging and the laparoscopic technique have made IPAA a safer, more effective and enduring operation.
机译：摘要目的手术技术不断发展为了进步的压力。袋肛门吻合术(IPAA)就是一个很好的例子。我们在练习分析变化的影响IPAA技术及其结果。患者主要IPAA机构被分为三组IPAA日期:从1983年到操作1993年,从1994年到2004年,从2005年到2015年。人口统计资料,病人并发症,手术技术,术后的结果,袋功能和生活质量进行了分析。结果,4525例患者主要IPAA。每十年,越来越多的外科医生参与(十年我,8;患者往往是病情加重(更高的美国人麻醉医师协会)和三十分举行袋变得更加普遍。最初的袋,袋成为主导,mucosectomy率为12%标准。过去的十年。十年38.3% vs 50% vs 48% (P ?0.0001),但后期发病率从74.2%下降通过67.1%至30% (P ?功能结果有所改善,但是生活的质量成绩没有。维护(94% vs 95.2% vs 95.2%;0.06)。新一代的外科医生,更准确适当诊断、分期和腹腔镜技术使IPAA更安全,更有效和持久的操作。

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