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。     

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。     

Laparoscopic surgery for ulcerative colitis

Laparoscopic techniques have revolutionized management of colorectal diseases; however, inflammatory diseases of the intestine have proven challenging because of the technical demands of their nature. Intense investigation and subsequent refinements in technique and technology have recently led to considerable advances and a clear role for laparoscopic management of Crohn's disease. and diverticulitis; laparoscopy for ulcerative colitis has not proven as promising. Laparoscopic procedures for ulcerative colitis require a significant learning curve. Although numerous experienced laparoscopic teams have documented their ability to complete them, long operative times and elevated rates of morbidity in some studies appear to counter the advantages. The question remains as to the universal application and appropriateness of these procedures in surgical management of ulcerative colitis.     

Restorative proctocolectomy for ulcerative colitis

The results of 36 restorative proctocolectomies (with 2-loop reservoir) for ulcerative colitis (UC) performed in a three-year period were surveyed. These patients represented 69% of all those undergoing definitive surgery for UC at the same time at our department. There was no operative mortality. Both early (44.4%) and late complications (45.2%) were quite common, but they were mostly minor and only two were permanent failures (5.6%) requiring construction of conventional ileostomy. Anastomotic retraction and sinus formation (25%), as revealed by pouch x-ray, were the most frequent early complications, occurring in a lesser degree (19.4%) also after stoma closure. Pouchitis was also a common (20%) late complication, but usually resolved promptly with metronidazole treatment. The functional results in the 23 patients evaluated were satisfactory, with a mean defaecation frequency of 5.4 per 24 hour and a minor soiling frequency of 36%. None of the patients had to wear a pad. The over-all results are compatible to those from other centres and suggest that acceptable anal function follows restorative proctocolectomy in most suitable cases with UC. The role of adequate surgical experience and consideration of contraindications must, however, be emphasised, and the surgeon must be ready to handle many minor and even major complications.     

Ileorectal anastomosis for ulcerative colitis

Several options can be considered when medical management of ulcerative colitis fails or if a serious complication develops. One alternative to proctocolectomy with ileostomy or ileoanal pull-through is the ileorectal anastomosis. Its main advantage is preservation of the rectal reservoir without risking injury to the pelvic nerves or and sphincter. It is not indicated when the rectum is severely diseased or stenosed or in the presence of rectal carcinoma. Patients older than 55 to 60 years can expect a good functional result in a relatively short time compared with the prolonged adaptation period associated with pull-through procedures.     

Surgery for ulcerative colitis.

Ulcerative colitis is an inflammatory condition of unknown aetiology affecting all or part of the rectum and colon. The mainstay of treatment is medical but there are specific indications for surgical intervention. This article reviews the evolution of surgical management and in particular compares outcome from proctocolectomy and pouch surgery. A number of factors determining choice of procedure are examined, including elective or emergency presentation, patient selection, technical issues, morbidity and quality of life. Emphasis is made regarding a full explanation of these factors so that the patient is fully involved in the final decision regarding choice of procedure.     

Sphincter saving operation for ulcerative colitis

For the purpose of attaining radicality, proctocolectomy with ileostomy is a very useful operative method in ulcerative colitis. On the other hand, an operative method which avoids colostomy or ileostomy and employs a sphincter-saving operation when possible is to be favored because this disease usually develops in young and is benign disease. In Japan, the frequency of sphincter-saving operations has increased gradually. Sphincter-saving operations (SSO) have been performed in 21 cases, and the therapeutic results of this operative method will be reported in this paper. Where no stenosis of the recto-anal region is observed, the SSO can be performed even if the rectal lesion is in active stage. The SSO can be performed safely by the multistage operative method even in cases indicated for emergency or urgent operation. The dependence on pharmacotherapy after operation is reduced by setting the range of SSO below the peritoneal reflection. The incidence of anastomotic leak is hight as a post operative complication. Measures to prevent it are important. Autosuture is useful in this capacity. Bowel function after operation does not interfere with social rehabilitation.     

Laparoscopic restorative proctocolectomy for ulcerative colitis

Background With increasing experience, laparoscopic techniques have been applied even to extended colorectal operations as restorative proctocolectomy for ulcerative colitis and familial adenomatous polyposis [1–10]. Methods A 36-year-old woman with a 7-year history of ulcerative colitis was transferred for elective surgery 6 weeks after an episode of toxic megacolon treated conservatively. The procedure was performed in modified lithotomy position using six trocars. After initial medial transection of the three main vascular pedicles of the ileocolic and middle colic vessels and the inferior mesenteric artery and vein, the colon was dissected free laterally, from the sigmoid orally toward the ileum. Special consideration was necessary for dissection of the omentum. The rectum was mobilized down to the pelvic floor in two steps, starting at the level of the promontory and the upper rectal stalks. It was transected at the level of the dentate line. Through a Pfannenstiel incision, the bowel was extracted. After transection of the ileum and removal of the specimen, a J-pouch was created. The anastomosis was completed laparoscopically using a double-stapling technique. Finally, a diverting loop ileostomy was created. Results A total of 13 patients underwent surgery. The medium age of these patients was 25.5 years (range, 19–57 years). There was no conversion to an open procedure. The median length of hospital stay was 11.5 days (range, 7–107 days). Four patients experienced major complications, including one case each of pouch failure after arterial occlusion, pouch–vaginal fistula, infected hematoma, and intraabdominal abscess formation. There was no postoperative mortality. Conclusions For restorative proctocolectomy, laparoscopic techniques proved to be safe and feasible. With further experience, they may have the potential to become an appealing alternative to open surgery. This article contains a supplementary video. This multimedia article (video) has been published online and is available for viewing at . Its abstract is presented here. As a subscriber to Surgical Endoscopy you have access to our SpringerLink electronic service, including Online First     

Proctocolectomy for colon cancer associated with ulcerative colitis a few months after living donor liver transplantation for primary sclerosing cholangitis: Report of a case

Colorectal cancer (CRC) frequently develops in patients with ulcerative colitis (UC). We report a case of CRC treated successfully by proctocolectomy 8 months after living donor liver transplantation (LDLT) for primary sclerosing cholangitis (PSC). The lesion was detected early, probably as a result of colonoscopic surveillance after LDLT. Thus, patients with a long history of UC, who undergo LDLT for PSC, should be followed up with regular surveillance colonoscopy. Moreover, surgery, such as radical resection of the colon and rectum should be performed without delay, even shortly after LDLT. To our knowledge, this is the first report of a patient undergoing proctocolectomy after LDLT.