溃疡性结肠炎手术治疗指南

溃疡性结肠炎患者在我国日益增多。溃疡性结肠炎经内科治疗无效或出现并发症时需行手术治疗。美国结直肠外科医师协会于2014年第1期（Diseasesof Colon＆Rectum》发表《溃疡性结肠炎手术治疗指南》。我们获得了杂志主编以及版权部门的许可，翻译此文，以便与更多的国内同行共同学习。     

溃疡性结肠炎的外科治疗16例分析

目的探讨溃疡性结肠炎的外科治疗方式。方法对16例行外科手术治疗的溃疡性结肠炎的临床资料进行回顾性分析。结果本组16例行外科手术治疗，占全部收治患者的20．5％（16／78）。手术原因包括保守治疗无效10例，肠梗阻3例，合并息肉可疑癌变3例。行全结直肠切除、回肠造口术8例，全结直肠全切除、回肠肛管吻合术4例，结肠全切除、回直肠吻合术2例，结肠部分切除2例。结论溃疡性结肠炎主要手术指征为内科治疗无效或合并肠梗阻及并发息肉可疑癌变者。全结肠切除、回肠造口术治疗较彻底，全结直肠切除、回肠贮袋肛管吻合术可改善排便控制功能，但吻合口溃疡发生率高。     

溃疡性结肠炎18例外科治疗体会

目的探讨溃疡性结肠炎的外科治疗。方法对18例外科手术治疗的溃疡性结肠炎的临床治疗进行回顾性分析。结果全组均经手术治疗，无围术期死亡，术后无主要并发症。结论全结肠切除、回肠造口术治疗较彻底，全结肠直肠切除，回肠贮袋肛管吻合术可以改善排便控制功能，是目前治疗溃疡性结肠炎较好的手术方式。     

重症溃疡性结肠炎手术治疗分析

目的 评价不同手术方式治疗重症溃疡性结肠炎（UC）的治疗效果.方法 收集1996年1月至2008年12月间华西医院收治的29例重症UC手术病例的临床资料,除2例部分结肠切除外,其余27例按不同的切除方式分为全结肠切除（TC组,7例）和全结直肠切除（TPC组,20例）;按不同的吻合方式分为回肠储袋肛管吻合（IPAA组,8例）、回肠直肠（IRA）或同肠肛管（IAA）吻合（直接吻合组,14例）和回肠造口（造口组,5例）.采用CGQL量表法进行术后生活质量（QOL）评估.结果 TPC组和TC组术后并发症的发生率分别为60.0%和57.1%,差异无统计学意义（P＞0.05）;复发率分别为15.0%和57.1%,差异有统计学意义（P＜0.05）.IPAA组和直接吻合组术后并发症的发生率分别为6/8和50.0%,差异无统计学意义（P＞0.05）;术后1年排便次数分别为（5.6±1.7）次/d和（9.1±2.9）次/d,差异有统计学意义（P＜0.05）;两组术后QOL均较术前明显改善（P＜0.01）,但两组之间差异并无统计学意义（P＞0.05）.结论 TPC-IPAA是目前治疗重症UC较为理想的手术方式;TC-IRA则是对有生育要求患者的首选术式,但术后需严格内镜随访、监测复发及恶变情况.     

溃疡性结肠炎的外科治疗

溃疡性结肠炎 ( ulcerative colitis,UC)是发生在结直肠的一类非特异性炎症性疾病 ,常常与Crohn病共同被称为炎症性肠病。本病在欧美发病率较高 ,近年我国发病率也有增高的趋势 ,在最近的 1 0年中 ,发病人数增加了 3.0 8倍 [1]。国外报道好发年龄为 30岁左右 ,国内统计的发病高峰年龄为40 .7岁 ,男女发病率相似[1] 。该病多具有慢性病史并反复发作 ,以下腹部隐痛不适 ,大便次数增多伴黏液便、血便为主要临床表现。目前病因尚不十分明确 ,主要有细菌、病毒感染学说 ,基因学说、自身免疫性疾病学说等 ,并可能与种族、心理因素、吸烟及饮食有…     

重症溃疡性结肠炎手术治疗分析

Objective To evaluate the role of different procedures in the treatment of severe ulcerative colitis (UC) requiring colectomy. Methods A total of 29 UC inpatients who underwent colectomy at the West China Hospital between January 1996 and December 2008 were included in this study. Except two cases who underwent partial colectomy,patients were divided into total colectomy group(TC group,n=7) and total proctocolectomy group(TPC group,n=20), meanwhile divided into ileal pouch-anal anstomosis (IPAA,n=8) group,straight end-to-end anastomosis (ileoanal or ileorectal and ileostomy)group (n=14)and ileostomy group (n=5). Quality of life (QOL) was assessed using the Cleveland Global Quality of Life (CGQL) instrument. Results The complication rate was 60.0% in TPC group and 57.1% in TC group (P＞0.05). The recurrence rate was 15.0% in TPC group and 57.1% in TC group (P＜0.05). The complication rate was 6/8 in IPAA group and 50.0%(7/14) in straight end-to-end anastomosis group(P＞0.05). The frequency of daily bowel movements in IPAA group was significantly lower than that in straight end-to-end anastomosis group at 1 year after the surgery(5.6±1.7 versus 9.1±2.9,P＜0.05). QOL was significantly improved postoperatively for all the patients (P＜0.01 ). Patients who underwent IPAA had a better QOL than those of straight end-to-end anastomosis group (P＞0.05). Conclusions TPC-IPAA is the ideal procedure of severe UC with acceptable complication rate, satisfactory quality of life and functional outcome.     

重症溃疡性结肠炎手术治疗分析

Objective To evaluate the role of different procedures in the treatment of severe ulcerative colitis (UC) requiring colectomy. Methods A total of 29 UC inpatients who underwent colectomy at the West China Hospital between January 1996 and December 2008 were included in this study. Except two cases who underwent partial colectomy,patients were divided into total colectomy group(TC group,n=7) and total proctocolectomy group(TPC group,n=20), meanwhile divided into ileal pouch-anal anstomosis (IPAA,n=8) group,straight end-to-end anastomosis (ileoanal or ileorectal and ileostomy)group (n=14)and ileostomy group (n=5). Quality of life (QOL) was assessed using the Cleveland Global Quality of Life (CGQL) instrument. Results The complication rate was 60.0% in TPC group and 57.1% in TC group (P＞0.05). The recurrence rate was 15.0% in TPC group and 57.1% in TC group (P＜0.05). The complication rate was 6/8 in IPAA group and 50.0%(7/14) in straight end-to-end anastomosis group(P＞0.05). The frequency of daily bowel movements in IPAA group was significantly lower than that in straight end-to-end anastomosis group at 1 year after the surgery(5.6±1.7 versus 9.1±2.9,P＜0.05). QOL was significantly improved postoperatively for all the patients (P＜0.01 ). Patients who underwent IPAA had a better QOL than those of straight end-to-end anastomosis group (P＞0.05). Conclusions TPC-IPAA is the ideal procedure of severe UC with acceptable complication rate, satisfactory quality of life and functional outcome.     

13例溃疡性结肠炎外科治疗的体会

目的探讨溃疡性结肠炎的外科治疗方法。方法对13例外科治疗的溃疡性结肠炎的临床资料进行回顾性分析。结果13例患者中,6例全结直肠切除、回肠贮袋肛管吻合术（IPAA）,4例全结直肠切除、回肠肛管吻合术,3例全结直肠切除术、回肠造瘘术。结论积极早期的手术治疗能够根除疾病并消除癌变可能,IPAA是目前UC择期手术的患者较好的手术方式。     

溃疡性结肠炎的外科治疗

溃疡性结肠炎（ulcerative colitis，UC）是发生在结直肠黏膜的一种弥漫性的炎性病变，病因尚未明确，多数学者认为与遗传、饮食、自身免疫等多种因素有关。本病以欧美多见，国内发病率较低，但近年有上升趋势。UC属于内科治疗范畴，但有20％～30％的患者内科治疗无效或出现并发症，需手术治疗，故外科医生应熟知UC的病理特点，正确诊断和选择合理的手术方式。现就UC的手术指征、手术方式、围手术期处理等方面的问题综述如下。     

溃疡性结肠炎的治疗（附193例分析）

为了解炎性肠病的治疗变迁，本文随访分析了该院１９５８～１９９４年间收治的溃疡性结肠炎１９３例，对比了前２０年和近１７年的发病情况和治疗效果。发现近１０余年诊治该病由年平均４例．上升达６．６例；但重症或转外科治疗的病例明显减少，未再出现合并肠穿孔或中毒性巨结肠病例。近９０％病人经内科治疗痊愈或好转，外科手术死亡率前２０年为４３％（９／２１），１９７８年后无１例死亡（０／６）。作者认为，近年治疗效果的提高，除一般病人体质改善外，与抗菌药物趋向完善，充分的静脉营养支持和选择恰当的手术方式有关。     

顽固性溃疡性结肠炎的外科治疗

目的 评价顽固性溃疡性结肠炎(ulcerative colitis,UC)患者采用全结直肠切除、回肠贮袋肛管吻合手术(ileal pouch-anal anastomosis,IPAA)治疗的临床效果和应用价值.方法 对1990—2010年60例符合手术指征的顽固性UC患者行IPAA治疗,观察分析其术后近期、远期并发症,评价肛门自制功能及术后粪便性状分类,采用克利夫兰生活质量量表(Clevend Global Quality of Life index,CGQL)进行手术前后生活质量评估对比,采用单因素方差方法进行统计分析.结果 60例术后随访均2年以上.术后近期并发症发生率为15％ (9/60),包括腹腔、盆腔感染、贮袋吻合口漏、贮袋出血、贮袋阴道瘘和肠梗阻等,远期并发症发生率12％(7/60),包括贮袋炎、肠梗阻和男性性功能障碍等.术后12个月的24 h和夜间大便次数分别为(3.5±1.3)次和(1.4±0.6)次.气便分辨能力良好者93％(56/60),需要日常戴垫者3％(2/60).Kirwan分级评价肛门自制功能结果为Ⅰ级者54例(90％),Ⅱ级者4例(7％),Ⅲ级者2例(3％).Bristol粪便分类评价结果为Ⅳ类者31例(52％),V类者25例(42％),Ⅵ类者4例(6％).CGQL量表法评价IPAA手术前后生活质量,术后较术前明显改善(F=12.368,P＜0.05).结论 顽固性UC具备外科治疗指征,IPAA是首选术式,临床应用安全,疗效满意,生活质量明显改善.     

溃疡性结直肠炎的外科治疗

目的介绍一种全大肠切除回肠与肛管一期吻合治疗溃疡性结直肠炎的方法。方法本术要求在直肠游离达肛提肌水平后继续推进于直肠内外括约肌之间,使直肠从肛管内翻拖出后,皮肤、齿状线及直肠粘膜成同一平面,其间无间沟及反折。在齿缘水平回肠与肛管于肛外行一期吻合。结果本组16例。主要表现为严重便血、腹泻贫血及营养不良。均经过长期的内科治疗。癌变的两例病史分别为7年、17年。术后一个月内每周排便6～12次,3个月后正常。16例中随访6个月～5年,均获治愈。结论因其结直肠切除彻底故而无复发,回肠肛管血运极其丰富,吻合易于成功。     

Surgical management of ulcerative colitis and Crohn's disease

The term inflammatory bowel disease is used to describe two conditions ‒ ulcerative colitis and Crohn's disease. Due to the complex nature of the disease, the treatment can be varied from each case to case and is usually approached by multidisciplinary team management. In this article, we focus on the surgical treatment options for inflammatory disease especially relating to basic principles.     

中西药交替灌肠治疗溃疡性结肠炎30例

目的 中西医结合灌肠与单纯常规西药口服、静滴治疗溃疡性结肠炎的疗效比较.方法 治疗组30例,采用中药自拟方与西药交替灌肠;对照组30例采用单纯西药口服、肌注、静滴.结果 总有效率治疗组98%,对照组68%,两组差异有统计学意义(P<0.05);复发率治疗灌肠组10%,对照组40%(P＜0.05);不良反应:灌肠组未出现明显不良反应,对照组有不同程度头痛、恶心、满月脸等.结论 中西药交替保留灌肠治疗溃疡性结肠炎,临床观察疗效明显,基本无不良反应.     

溃疡性结肠炎的手术治疗

尽管溃疡性结肠炎的内科治疗已经取得了很大的进步．仍有相当一部分患者需要手术治疗。回肠储袋肛管吻合术（IPAA）在目前西方国家最为常用：回直肠吻合（IRA）仍有一定的临床应用价值。临床上对于手术方式的选择往往需要根据具体的临床情况、在患者充分知情同意后决定。     

外科治疗15例溃疡性结肠炎的临床体会

目的:探讨溃疡性结肠炎的外科治疗体会,提高对本病救治水平。方法:对15例外科治疗的溃疡性结肠炎的临床资料进行回顾性分析。结果:本组15例患者中,行全结直肠切除、回肠造口术4例;全结肠切除、回肠直肠吻合术4例;全结肠直肠切除、回肠贮袋肛管吻合术7例。结论:全结肠切除、回肠造口术治疗较彻底,全结肠直肠切除、回肠贮袋肛管吻合术可改善排便控制功能但吻合口溃疡发生率高。对于常见的吻合口瘘并发症,通过持续骶前引流等保守治疗,可使吻合口瘘闭合。"J"型全结肠直肠切除、回肠贮袋肛管吻合术是目前治疗溃疡性结肠炎较好的手术方法。     

Transanal mucosectomy using an ultrasonically activated scalpel for ulcerative colitis

(Received for publication on Dec. 26, 1997; accepted on Sept. 11, 1998)     

Appraisal of surgical treatment for distal ulcerative colitis

Most patients with ulcerative colitis respond well to medical treatment, however surgical treatment may be required in cases with severe clinical symptoms. We treated eight patients with distal ulcerative colitis (DUC), limited to the rectum and distal sigmoid colon, who were treated at St. Mark's Hospital by excision of the rectum and sigmoid colon with permanent colostomy. Four who did not respond to medical treatment and had severe and intermittent symptoms of long-standing, three with no control of the distressing diarrhea with a shorter history, and those with a severe dysplasia evidenced by rectal biopsy were surgically treated. Two of eight had a recurrence at the proximal colon within 6 and 10 years respectively but responded well to conservative management. From these observations it concluded that the procedure for patients with DUC may be one of adequate operations. Histological features of the resected specimens did not relate to the postoperative outcome of these patients.