改道性结肠炎治疗进展

改道性结肠炎(diversion colitis,DC)是在结肠或回肠造口术后无粪流通过的旷置结肠段粘膜的非特异性炎症。尽管绝大多数肠道造口患者无症状,但几乎所有粪便改道患者均可出现DC。DC的临床症状主要有腹痛、里急后重、便血以及排粘液分泌物等,且随着肠管旷置时间延长而炎症可日渐加重,进而不同程度影响了这类患者的生活质量。然而,国内对DC的研究甚少,对DC的认识有限,因而还未引起临床医生的足够重视。鉴于此,我们在本文中对DC的表现及治疗方面的研究进展作一综述,以期能够提高临床对改道性结肠炎的认识,同时帮助临床医生做出更好的治疗决策。     

结肠透析联合中药保留灌肠治疗溃疡性结肠炎效果观察

目的探讨结肠透析联合中药灌肠辅助治疗溃疡性结肠炎的效果。方法对66例渍疡性结肠炎患者按住院时间的顺序分为对照组（36例）和观察组（30例），对照组采取传统中药保留灌肠，观察组用结肠透析仪行结肠灌洗，再注入中药保留灌肠治疗。结果观察组治疗总有效率显著高于对照组（P〈0.01）；肠道内药物保留效果显著优于对照组（P〈0.05）。结论结肠透析联合中药保留灌肠可提高渍疡性结肠炎疗效。     

基于自我效能理论框架的营养教育在直肠癌预防性回肠造口者中的应用效果分析

目的:探讨基于自我效能框架的营养教育在直肠癌预防性回肠造口患者中的应用效果。方法:选择2021年2月至2022年1月于我院拟接受预防性回肠造口的70例直肠癌患者为研究对象,根据随机数字表法将其分为研究组和对照组,各35例。对照组接受常规健康教育,研究组在对照组基础上接受基于自我效能理论框架的营养教育。比较2组干预前、出院前1 d、出院后1个月和3个月患者的BMI、白蛋白、血红蛋白、淋巴细胞计数,以及干预前、出院后3个月患者的自我效能评分及整体营养状况。结果:干预前、出院前1 d、出院后1个月,2组BMI比较差异无统计学意义,P>0.05;出院后3个月,研究组患者BMI明显高于对照组,P<0.05。干预前、出院前1 d, 2组患者白蛋白、血红蛋白、淋巴细胞计数指标水平比较差异无统计学意义,P>0.05;出院后1个月、3个月,研究组白蛋白、血红蛋白、淋巴细胞计数指标水平均高于对照组,P<0.05。干预前2组患者造口自我效能评分、整体营养状况评分比较差异无统计学意义,P>0.05;出院后3个月2组患者自我效能评分均明显升高、整体营养状况均明显改善,且研究组优于对...     

改良式保留灌肠法治疗溃疡性结肠炎效果观察

目的 探讨改良式中药保留灌肠法治疗溃疡性结肠炎的疗效。方法 将150例渍疡性结肠炎患者随机分为观器组（100例）和对照组（50例）．对照组采用传统灌肠方法．观察组采用一次性双腔气囊导管代替肛管，保持灌肠液适宜温度、控制药液灌入速度的综合改进方法。结果 总有效率观察组为100％，常规组为82％．两组比较，差异有显著性意义（P〈0．01）。结论 改良式中药保留灌肠可防止药液外溢．保持灌肠液温度，确保药液在肠道内停留时间．促进药物吸收．提高渍疡性结肠炎的治疗效果。     

中药保留灌肠治疗溃疡性结肠炎效果观察

对40例溃疡性结肠炎患者采用中药保留灌肠治疗，即自制肠炎1号子患者保留灌肠，灌肠保留3h以上，每天1次，10d为1个疗程，治疗3个疗程。结果治愈7例，显效22例，有效8例，无效3例，总有效率92．5％，提示中药保留灌肠治疗溃疡性结肠炎疗效显著，且安全、可靠。     

中药保留灌肠治疗溃疡性结肠炎效果观察

对40例溃疡性结肠炎患者采用中药保留灌肠治疗,即自制肠炎1号予患者保留灌肠,灌肠保留3 h以上,每天1次,10 d为1个疗程.治疗3个疗程.结果 治愈7例,显效22例,有效8例,无效3例,总有效率92.5%,提示中药保留灌肠治疗溃疡性结肠炎疗效显著,且安全、可靠.     

清洁肠道联合中药保留灌肠治疗溃疡性结肠炎的效果观察

为观察清洁肠道联合中药保留灌肠治疗溃疡性结肠炎的效果,将83例该病患者按就诊先后顺序分组,治疗组40例采用结肠透析机清洁肠道联合辨证中药煎剂保留灌肠法治疗,对照组43例采用辨证中药煎剂常规保留灌肠法治疗,21d为一个疗程,并对两组症状体征积分、结肠黏膜变化评分、中药保留时间和药液外溢率进行对比分析。结果显示,两组患者治疗后症状体征和结肠黏膜均得到改善,P〈0．01;但治疗组较对照组改善更明显,P〈0．01。治疗组中药保留时间明显长于对照组,P〈0．01;治疗组药物外溢率低于对照组,P〈0．05。结果表明,清洁肠道联合中药保留灌肠法能使中药在肠道内保留时间延长,灌肠液外溢率明显减少,症状体征和结肠黏膜得到明显改善,从而显著提高疗效。     

慢性结肠炎药物保留灌肠剂量的研究

目的 探讨药物保留灌肠治疗慢性结肠炎的最佳灌肠剂量，为临床根据结肠病变部位选择合适的灌肠剂量提供依据。方法　采用抽签法将确诊为慢性结肠炎的240例患者随机分为4组（Ⅰ、Ⅱ、Ⅲ、Ⅳ组）各60例，每组均用添加染色剂（靛胭脂）的灌肠液进行保留灌肠，Ⅰ、Ⅱ、Ⅲ、Ⅳ组的灌肠剂量分别为100ml、200ml、300ml、400ml。每晚保留灌肠1次，观察各组灌肠后药液的保留时间，治疗2周后行电子结肠镜检查，观察药物到达的肠段及肠黏膜炎症改变情况。结果　各组灌肠后药液的保留时间、灌肠液到达的肠段情况及治疗效果比较，差异有显著性意义（P〈0．05，P〈0．01）。Ⅱ、Ⅲ组药液的保留时间、药液到达的结肠部位、治疗效果与其他两组比较，差异有显著性意义（P〈0．05，P〈0．01）。结论　灌肠剂量为100ml时药液到达的结肠部位较浅，治疗效果欠佳；剂量为400ml时患者耐受性差，肠道激惹现象强烈，药液保留时间较短，疗效不佳。药物保留灌肠最佳剂量为200～300ml，药液到达结肠的部位最理想，患者耐受性好，疗效最佳。     

中西药联合保留灌肠治疗慢性溃疡性结肠炎

近年来，我科采用中西药联合应用保留灌肠治疗慢性溃疡性结肠炎178例，疗效显著，现报告如下。     

改良式保留灌肠法治疗溃疡性结肠炎效果观察

目的探讨改良式中药保留灌肠法治疗溃疡性结肠炎的疗效.方法将150例溃疡性结肠炎患者随机分为观察组(100例)和对照组(50例),对照组采用传统灌肠方法,观察组采用一次性双腔气囊导管代替肛管,保持灌肠液适宜温度、控制药液灌入速度的综合改进方法.结果总有效率观察组为100%,常规组为82%,两组比较,差异有显著性意义(P<0.01).结论改良式中药保留灌肠可防止药液外溢,保持灌肠液温度,确保药液在肠道内停留时间,促进药物吸收,提高溃疡性结肠炎的治疗效果.     

白头翁汤灌肠辅助治疗溃疡性结肠炎的有效性及安全性的Meta分析

目的:评价白头翁汤灌肠辅助治疗溃疡性结肠炎(UC)的有效性及安全性。方法:检索中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP)、万方数据库、临床试验注册登记库、PubMed、Embase等,筛选随机对照试验研究,采用RevMan 5.3软件对结局指标数据进行Meta分析。结果:最终筛选14项研究,Meta分析结果显示:总有效率[RR=1.21,95% CI=(1.15,1.28),P<0.01];不良反应发生率[RR=0.50,95%CI=(0.27,0.92),P<0.01];腹痛积分[SMD=-1.05,95%CI=(-1.48,-0.62),P<0.01];腹泻积分对比[SMD=-1.32,95%CI=(-2.00,-0.65),P<0.01];里急后重积分[SMD=-2.95,95%CI=(-4.60,-1.29),P<0.01];脓血便积分[SMD=-1.91,95%CI=(-2.99,-0.83),P<0.01];Mayo评分[MD=-1.22<95,95%CI=(-1.85,-0.59),P<0.001];Baron评分[MD=-0.30,95%CI=(-0.45,-0.16),P<0.01];IL-10水平[SMD=1.17,95%CI=(0.90,1.43),P<0.01];TNF-α水平[SMD=-2.20,95%CI=(-3.48,-0.92),P<0.001];TNF-β水平[SMD=-1.54,95%CI=(-1.89,-1.18),P<0.01]。结论:白头翁汤灌肠治疗UC可以提升治疗总效果,缓解UC患者的腹痛、腹泻及脓血便等症状,并具有抑制肠道炎症反应,促进肠道黏膜损伤愈合的作用,具有更低的不良反应发生率,安全性较高,值得临床推广。     

肠舒汤保留灌肠对旷置性结肠炎病理改变的影响

目的:观察肠舒汤保留灌肠对末端回肠造口术后旷置性结肠炎病理改变的影响。方法:选择2015年12月—2018年6月在我科因梗阻性结肠癌或直肠癌保肛手术,一期肿瘤切除、吻合并行预防性末端回肠双腔造口的60例患者,随机均分为对照组和观察组,每组30例。对照组以温生理盐水经肛门插管逆行灌肠治疗,观察组以同法给予肠舒汤保留灌肠治疗,连续治疗2周,每天1次,在灌肠治疗前及灌肠治疗2周后各行1次电子结肠镜检查。检查整个旷置结肠的黏膜改变情况。结果:灌肠2周后,对照组患者旷置结肠的黏膜红斑肿胀有效率为26.67%,观察组为70.00%;对照组炎性滤泡增生的有效率为20.00%,观察组为47.82%;对照组溃疡糜烂的有效率为5.56%,观察组为45.00%。观察组红斑肿胀、滤泡增生的有效率显著优于对照组(P 0.05),溃疡糜烂及炎性息肉的有效率差异无统计学意义。结论:肠舒汤保留灌肠可以较好地修复旷置性结肠肠黏膜的损伤,促进肠黏膜的恢复。     

中西药物保留灌肠合并针灸治疗溃疡性结肠炎的临床研究

目的 观察中西药物保留灌肠合并针灸治疗溃疡性结肠炎(UC)的疗效.方法 对确诊的63例UC患者随机分为两组,治疗组(32例)用中西药物150 mL睡前保留灌肠合并针灸治疗,每日1次,疗程4周;对照组(31例)用强的松龙100 mg、庆大霉素16万u加生理盐水150 mL睡前保留灌肠,每日1次,疗程4周.然后比较疗效.结果 治疗组疗效明显高于对照组,总有效率分别为96.9%和77.4%,1年复发率分别为9.37%和25.8% (P<0.05).两组差异有统计学意义.结论 中西药物保留灌肠合并针灸治疗UC疗效显著,复发率低,有临床应用价值.     

Rectal cancer and ulcerative colitis: does it change the therapeutic approach?

Objective The aim of this study was to examine the incidence of coexisting colorectal cancer in ulcerative colitis in a population of patients undergoing ileal pouch anal anastomosis. The frequency of rectal cancer in this population, surgical intervention, general outcomes and cancer recurrence are described. Methods Data on 1850 patients undergoing restorative proctocolectomy from 1983 to 2001 were reviewed. Information was gathered from data in the department's pelvic pouch database, as well as pathology and surgical reports. Follow‐up questionnaires routinely sent to patients as part of the database were included in the analysis to determine current functional status. Mean follow‐up period was 7.5 years after surgery. Results Seventy patients had coexisting colorectal cancer at time of IPAA. 7 (10%) of cancers were incidental. Pre‐operative duration of disease was 18.6 years. Twenty‐six of the cancers were rectal cancers. The most common form of anastomosis in the rectal cancers was mucosectomy, especially in pre‐operatively known rectal cancer or low lying dysplasia. Preferred surgical technique for rectal cancer in mucosal ulcerative colitis (UC) included high ligation of mesenteric vessels with radical colectomy and taped occlusion of the rectum with irrigation of the rectal stump with Turnbull solution prior to mucosectomy. Patients with Stage 3 cancers received postoperative chemotherapy. Post‐operative radiation therapy was not commonly recommended. Five of 70 patients were deceased from metastatic colon cancer; 55 patients were confirmed alive with good to excellent pouch function with a follow‐up range of 1–17 years. Conclusion Restorative proctocolectomy with ileal pouch anal anastomosis is a successful surgical approach for patients with coexisting colorectal cancer in UC. When the appropiate surgical technique is used in patients with colon or rectal cancer, along with adjuvant chemotherapy when appropriate, prognosis and function is very good.     

Pull-through with isolated jejunal loop for ulcerative colitis

Total colectomy with endorectal mucosectomy and ileal pull-through to preserve fecal continence is well known for ulcerative colitis. A female patient developed severe ulcerative colitis at 5 years of age and had an emergency subtotal colectomy and ileostomy at 7 years of age. The rectum was preserved. At 9 years of age rectal mucosectomy and a pull-through using isolated jejunal loop were performed. Postoperatively she was treated with ano-rectal physiotherapy and balloon dilatations of the new rectum. Six months later the ileostomy was closed. Two and a half years after her operation she has 2-4 soft bowel movements daily, perfect diurnal control with occasional night soiling. A pull-through using an isolated loop of jejunum leaves intact a good functioning ileostomy. The blood supply to the jejunum is better than the terminal ileum. Bacterial contamination with jejunum is less than with ileum. There is no need for a reservoir; if the pull-through fails valuable terminal ileum is not lost.     

A modified biofeedback program for children with detrusor-sphincter dyssynergia: 5-year experience

PURPOSE: We reviewed our 5-year experience with a modified 4 to 6-session biofeedback program combining noninvasive urodynamic approaches with various psychological techniques, including externalizing the voiding problem, empowerment and praise, to treat children with detrusor-sphincter dyssynergia. MATERIALS AND METHODS: Biofeedback was performed with a urodynamics processor that enables simultaneous recording of urine flow and electromyography, and visual display of flow/electromyography activity. Initially normal and abnormal voiding were explained in a unique way and the children observed relaxation and contraction of the pelvic floor muscles while visualizing the electromyography monitor. The bladders were filled naturally and surface electrodes were placed. Psychological strategies were used to engage and motivate the children to achieve maximal cooperation. The children voided while attempting relaxation and post-void residual urine volume was measured by bladder scan. Special and specific praise was provided for progress and increasing self-esteem. Patients returned monthly to review these concepts and practice voiding. RESULTS: Of 87 children 77 completed the program, including 7 boys and 70 girls 3 to 17 years old (mean age 7.8) who required an average of 4.7 sessions (median 4). Results were achieved within 6 sessions in 82% of cases. Of the 77 children 59 (76%) had recurrent urinary tract infections, 38 (49%) had associated bladder instability, 19 (24%) had vesicoureteral reflux and 44 (58%) had constipation. Subjectively 47 patients (61%) reported pronounced improvement in urinary symptoms, while another 24 (32%) reported moderate improvement after biofeedback training. Objectively 47 children (61%) had normal flow with minimal electromyography activity during voiding and a normal post-void residual urine of less than 20% voided volume (p <0.002). In 28 cases (36%) flow studies improved (p <0.03) but post-void residual urine remained elevated. Vesicoureteral reflux resolved in 9 cases after biofeedback training. This approach was equally successful in children in all age groups. Those with more than a 2-year history of symptoms, poor bladder emptying and severe constipation had only moderate improvement. CONCLUSIONS: The modified biofeedback program including appropriate explanations and psychological approaches appeared effective for treating 92% of children with detrusor-sphincter dyssynergia. It is less invasive and requires less time than traditional methods, and patients are more compliant with treatment.     

术前营养风险筛查联合营养支持对结直肠癌患者的临床价值

目的 探讨术前营养风险筛查联合营养支持对结直肠癌患者腹腔镜手术后免疫功能、营养状态 和疗效的影响。方法 选择2016年1月至2018年6月在温州医科大学附属第一医院和温州医科大学附属慈 溪医院治疗的结直肠癌患者138例,根据术前营养风险评估,分为有营养风险组（n=53）和不存在营养风 险的对照组（n=85）,前者再分为接受营养支持组（A组,n=32）和未接受营养支持组（B组,n=21）。比较三 组术后肠功能恢复情况、免疫功能及相关营养指标。结果 A组首次排气时间、首次排便时间明显短于B 组（P<0.05）,但均较对照组延长（P<0.05）;A组和对照组半流质饮食时间及住院天数明显短于B组（P<0.05）; 术后,A组和对照组血清白蛋白（Alb）、前白蛋白（PA）和转铁蛋白（Tf）明显高于B组（P<0.05）,对照组血 清Alb和PA明显高于A组（P<0.05）;术后,三组IgA、IgG和IgM差异明显,其中A组各指标水平最高,对 照组次之,B组最低（P<0.05）;三组并发症发生率无明显差异（P>0.05）。 结论 术前营养风险筛查,对有 营养风险的结直肠癌患者给予肠内营养支持,可有效改善术后营养状况,提高免疫功能,促进术后恢复, 同时减少术后并发症的发生。     

A case of localized peritonitis caused by obstructive colitis proximal to rectal carcinoma: A rare manifestation of obstructive colitis

A case of obstructive colitis associated with rectal carcinoma in a 56 year old Japanese man is reported herein. He presented to Shinkokura Hospital with severe abdominal pain following a one month history of anal bleeding and mild abdominal pain. On palpation, muscle guarding was observed in the left lower quadrant and the white blood cell count was 14,200/mm³. An exploratory laparotomy was performed under the provisional diagnosis of acute abdomen, which revealed localized peritonitis 8 cm oral to an area of rectal carcinoma. An anterior resection of the lesion was therefore performed together with a descendo-proctostomy. The histopathologic diagnosis revealed adenocarcinoma and obstructive colitis involving the entire thickness of the sigmoid colon and resultant fibrino-purulent peritonitis. His postoperative course was uneventful and he was continuing to do well on the 30th postoperative day, at the time of writing. The clinical significance of this combination of obstructive colitis with rectal carcinoma is briefly discussed following the presentation of this case.