| Objective: to investigate the clinical characteristics of patients with familial adenomatous polyposis and to analyze the clinical factors that may be related to the malignant transformation of familial adenomatous polyposis.To compare the short-term clinical efficacy and safety of open and laparoscopic surgery in the treatment of familial adenomatous polyposis;to explore the factors affecting the short-term and long-term anal function of patients.Methods: A retrospective study was conducted on 79 patients with familial adenomatous polyposis who were treated in the Department of Colorectal and anal surgery of the first affiliated Hospital of Guangxi Medical University from January 2008 to September 2019.The clinicopathological manifestations,treatment methods,postoperative recovery and postoperative complications of the above patients were collected.All patients were more than 3 months after operation.The long-term anal function of the patients was evaluated by Wexner score during follow-up,the high risk factors of canceration group were analyzed,and the related factors affecting the long-term anal function of patients were analyzed.Results: 1.A total of 79 patients with familial adenomatous polyposis met the inclusion criteria,including 46 males(58%)and 33 females(42%).The average age was 34.8 years old,and the age range was 13 to 56 years old.Among the 79 patients,29 patients(36.7%)were diagnosed with polyp malignant transformation,of which 10 patients(34.5%)had simultaneous multiple source tumors,39 patients(44%)had family hereditary history,and only 29 patients(36.7%)had perfect gastroduodenoscopy at the beginning,including 18 patients with gastric fundus polyps or duodenal polyps(62.0%).2.Univariate analysis of familial adenomatous polyposis with malignant transformation showed that there were significant differences in age,course of disease ≥ 3 years,diameter of polyps and number of polyps(P < 0.05).Multivariate analysis showed that age,diameter of polyps and course of disease ≥ 3 years were related to malignant transformation(P < 0.05).The probability of canceration in patients with a course of disease ≥ 3years was 3.65 times higher than that in patients with a course of less than 3 years.Compared with non-cancerous patients,the average age of patients with canceration was older(40.7 years old,vs31.4 years,P < 0.05),and the maximum diameter of polyps was larger(50mm vs 15 mm,P < 0.05.The specificity is 78%.The age of canceration was earlier in patients with family history(35.6years vs49.1,P < 0.05),earlier in patients with hematochezia(35.6years old,vs45.6years),and earlier in patients with abdominal pain(33.1years old vs44.1 years,P< 0.05).The cumulative canceration rate of all patients and patients with family history before each age point was calculated and plotted into a line chart,which showed that the cancer rate of all patients increased significantly when the age was after 30 years old.The cancer rate of patients with family history increased significantly when they were between 26 and 35 years old,while that of patients without family history increased significantly after 36 years old.3.Among the 72 patients who underwent total colectomy,laparoscopic surgery was performed in40 patients(56%)and open surgery in 32 patients(44%).Compared with open total colectomy,laparoscopic surgery took longer(327.0min vs 261.8min P <0.05)and less bleeding(152.1ml vs 247.6ml P < 0.05).In laparoscopic surgery,the operation time before 2014 was longer than that after 2014(415 min vs 318 min P < 0.05),and the operation time of cancerous patients was longer than that of non-cancerous patients(392 min vs 291 min P < 0.05).Laparoscopic surgery was more likely to get out of bed than open surgery(3.23 d vs 4.63 d P < 0.05)and catheter removal(7.95 d vs 12.5 d P < 0.05).Open surgery is prone to postoperative urinary retention(15.6% vs 2.5% P < 0.05).There was no significant difference in the incidence of wound infection,intestinal obstruction,intestinal leakage,gastric emptying and postoperative hard fibroma between the two groups(P > 0.05).4.Among the 72 patients who underwent surgical treatment,39 patients(54.2%)underwent total colorectal resection and ileal pouch rectal anal anastomosis,and 20 patients underwent total colorectal resection and ileal pouch rectal anal anastomosis plus prophylactic enterostomy(27.8%,IPAA+ stomy group).Total colorectal resection and ileorectal anastomosis were performed in 6 patients(8.3%,marked as IRA group),and total colorectal resection plus permanent colostomy was performed in 7 patients(9.7%,marked as TC+ colostomy group).There were significant differences in age and ASA grade among the four groups(IPAA group,IPAA+ colostomy group,IRA group and TC+ colostomy group).Patients with older age and higher ASA score were more likely to choose TC+ colostomy group.There were significant differences in the time of getting out of bed,the time of exhaust,the time of fluid intake and the time of catheter removal among the four groups.IPAA group exhaled later and ate fluid later than other groups.Postoperative intestinal obstruction was more likely to occur in IPAA+ colostomy group and IPAA group than in other groups.Among the surgical patients,intestinal leakage occurred in8 cases(12.3%),including 2 cases(10%)after prophylactic colostomy and 6 cases(13.3%)without prophylactic colostomy.Although the incidence of anastomotic leakage after prophylactic colostomy was low,there was no significant difference between the two groups(P > 0.05).5.There was no significant difference between laparoscopic surgery and open surgery in the presence of stoma,colostomy time,Wexner score and postoperative long-term voiding dysfunction(P > 0.05.the frequency of defecation in);IPAA was more than that in IRA(11.4 vs7,P < 0.05),and the frequency of defecation in pouch ≤ 10 cm was more than that in pouch >10cm 10 days after operation(13.9 vs9.5,P < 0.05).The scatter plot of Wexner score and follow-up time showed that the Wexner score of the patients was higher within 1.3 years after operation and decreased significantly with the extension of postoperative time,while the Wexner score of 1.3-5 years after operation tended to decrease slightly with the extension of postoperative time,and tended to be stable at 5 years after operation,indicating that most of the anal function had recovered about 1.3 years after operation,and the anal function of patients tended to be stable 5 years after operation.Univariate statistical analysis of Wexner score of long-term anal function showed that there were statistical significance in operative age > 35 years,postoperative time > 5 years,mode of operation and distance between anastomosis and anus > 2cm(ileo-anal anastomosis or ileorectal anastomosis)and intestinal leakage(Wexner score).Multivariate analysis showed that the age of operation > 35 years old,the mode of operation(IPAAor IRA),the distance between anastomosis and anus > 2cm,and intestinal leakage were the influencing factors of Wexner score of long-term anal function.Conclusion: 1.The proportion of patients with familial adenomatous polyposis with family history is not high,so family history can not be used as the basis for the diagnosis of familial adenomatous polyposis.2.There is a high rate of familial adenomatous polyposis complicated with upper gastrointestinal adenoma,so we should pay attention to the upper gastrointestinal laparoscopic examination of familial polyposis.3.Patients with familial adenomatous polyposis have a higher canceration rate with age.Patients with family history may have a better clinical outcome in dealing with the disease before 26 years old,while patients without family history should strive for prophylactic colorectal resection before 30 years old.4.there was no significant difference in the incidence of complications between open and laparoscopic treatment in patients with familial adenomatous polyposis.Laparoscopic surgery is safe and effective in the treatment of familial adenomatous polyposis 5.Laparoscopic surgery for familial adenomatous polyposis takes longer and needs a certain learning curve to learn.Compared with open surgery,laparoscopic surgery has the advantages of less bleeding and faster recovery.6.The recovery after IPAA is slower,and postoperative intestinal obstruction is more likely to occur than other surgical methods.7.The mode of operation will affect the patient’s long-term anal function.Clinically,we should choose to retain part of the patient’s rectum as much as possible in order to improve the anal function.8.The incidence of intestinal leakage after total colectomy is higher,preventive colostomy can not reduce the incidence of intestinal leakage,but preventive colostomy can restore intestinal function earlier and reduce the symptoms after intestinal leakage.and preventive colostomy can reduce the symptoms around anastomotic leakage,which may contribute to the recovery of patients’ anal function. |
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