炎症性肠病152例临床病理分析

为探讨炎症性肠病（IBD）的临床病理特点和治疗方法,回顾性分析152例IBD患者的临床资料,肠镜、病理检查及治疗方法。结果显示,临床主要表现：93例溃疡性结肠炎（UC）以腹泻为主,伴有腹痛和黏液脓血便,腹痛多位于左下腹和左腰腹部;59例克罗恩病（CD）以腹痛为主,伴有腹泻和黏液或水样便,腹痛多位于右下腹和脐周。病变范围：UC以直肠和全结肠为主;CD以末端回肠及其邻近结肠为主。临床类型：UC以初发型及慢性复发型多见;CD以狭窄型为主。内镜及病理大体检查：UC为多发性表浅溃疡、连续性弥漫性黏膜充血糜烂,病理检查镜下隐窝脓肿较多见;CD为节段性、非对称性的黏膜炎症,病理检查镜下黏膜下层见结节样肉芽肿。CD并发症较多,主要为肠梗阻、瘘管及肠穿孔。UC结肠镜病理活检确诊率为96．8％,3．2％的病例是经手术标本病理活检确诊。CD结肠镜病理活检确诊率为59．3％,40．7％的病例是经手术标本病理活检而确诊。结果表明,IBD临床表现多样,CD并发症较UC多见,误诊率较高,结肠镜病理活检是诊断UC和CD的有效方法。合理内科治疗和选择性外科治疗可提高IBD的治疗效果。     

炎性肠病肠道免疫学的研究进展

目的总结有关炎性肠病肠道免疫学领域的最新进展。方法采用文献复习的方法,对炎性肠病包括溃疡性结肠炎及克罗恩病免疫学领域的相关文献进行综述。结果溃疡性结肠炎和克罗恩病是炎性肠病的两种主要类型,两者的临床和病理特征既有重叠又有区别。免疫学的研究表明,易感个体对肠道微生物"过激"的炎症反应以及机体与微生物之间的相互作用在炎性肠病发生、发展中发挥重要作用。这一领域的突出成果包括发现了核苷酸结合寡聚化结构域2(NOD2)基因、自体吞噬基因、微RNA、白细胞介素23/Th17通路等。肠道细菌、肠上皮、肠道免疫细胞以及肠道微血管的功能异常在炎性肠病的病程进展中起关键作用。目前一些单克隆抗体已被用来治疗炎性肠病,并取得良好效果。结论对炎性肠病发病过程中肠道黏膜免疫基础和分子网络调控的研究,将为炎性肠病的防治提供理论依据;对炎性肠病相关基因的研究,又可为炎性肠病治疗提供更多的基因治疗靶点。     

Single-Site Laparoscopic Surgery for Inflammatory Bowel Disease

Background and Objectives:

Single-site laparoscopic colorectal surgery has been firmly established; however, few reports addressing this technique in the inflammatory bowel disease population exist.

Methods:

We conducted a case-matched retrospective review of 20 patients who underwent single-site laparoscopic procedures for inflammatory bowel disease compared with 20 matched patients undergoing multiport laparoscopic procedures. Data regarding these patients were tabulated in the following categories: demographic characteristics, operative parameters, and perioperative outcomes.

Results:

A wide range of cases were completed: 9 ileocolic resections, 7 cases of proctocolectomy with end ileostomy or ileal pouch anal anastomosis, 2 cases of proctectomy with ileal pouch anal anastomosis, and 2 total abdominal colectomies with end ileostomy were all matched to equivalent multiport laparoscopic cases. No single-incision cases were converted to multiport laparoscopy, and 2 single-incision cases (10%) were converted to an open approach. For single-incision cases, the mean length of stay was 7.7 days, the mean time to oral intake was 3.3 days, and the mean period of intravenous analgesic use was 5.0 days. There were no statistically significant differences between single-site and multiport cases.

Conclusions:

Single-site laparoscopic surgery is technically feasible in inflammatory bowel disease. The length of stay and period of intravenous analgesic use (in days) appear to be higher than those in comparable series examining outcomes of single-site laparoscopic colorectal surgery, and the outcomes are comparable with those of multiport laparoscopy. This may be because of the nature of inflammatory bowel disease, limiting the benefits of a single-site approach in this population.