溃疡性结肠炎的外科微创治疗

外科治疗是溃疡性结肠炎(ulcerative colitis,UC)的重要组成部分,全结直肠切除、回肠贮袋肛管吻合术(ileal pouch-anal anastomosis,IPAA)已成为标准术式.近年来在微创外科技术的迅猛发展与普及下,越来越多医疗中心开展腹腔镜IPAA手术.腹腔镜IPAA手术相比于开腹手术的在术后近、远期疗效中的优势逐渐突显,且其安全有效性已达成共识.目前更多更为微创的技术也陆续尝试应用于IPAA手术.但是由于UC患者自身疾病的特点和IPAA术式的复杂性,腹腔镜IPAA手术仍未达到标准化、规范化水平.本文主要针对UC微创外科术后疗效和合理应用的研究进展作一述评.     

溃疡性结肠炎的手术指征、手术方式及围手术期管理

溃疡性结肠炎是炎症性肠病（IBD）的一种表现类型,发病部位主要集中在结直肠,其并发症主要为出血、穿孔、癌变及反复发作引起梗阻。溃疡性结肠炎与克罗恩病不同,溃疡性结肠炎是可以通过手术而达到根治的,且手术后的复发率及并发症率都较低,手术对于溃疡性结肠炎的患者有着更重要的意义。而手术指征、手术方式和围手术期的管理与手术的效果及术后患者的生活质量都有着密切的关系,所以对外科医生的经验及技术提出了较高的要求。本文主要集中探讨外科治疗溃疡性结肠炎的手术指征、手术方式及围手术期处理等问题。     

重视溃疡性结肠炎的规范化外科治疗

我国溃疡性结肠炎(ulcerative colitis,UC)的发病率近20年来呈现快速上升趋势,但由于既往的低发病率以及结直肠外科亚专业化在我国的发展不足,国内对溃疡性结直肠炎的诊断治疗在相当程度上还存在一定盲区。与国外新的治疗理念相比,我国还存在诸多问题,如对内科治疗的过度依赖,对外科手术指征的过严把控,手术方式的选择上存在明显差异、对癌变的监控及早期处理严重不足等。因此迫切需要提高相关科室人员对UC诊断治疗标准的知晓,强化区域炎症性肠病(inflamatory bowel diseases,IBD)诊治中心的建设,大力推动UC诊治指南的宣传与应用,是提高我国UC治疗水平的关键。     

炎症性肠病的治疗

炎症性肠病的治疗包括内科和外科治疗两种。内科治疗的目的在于尽快控制急性发作症状并防止复发,当出现严重并发症时则常有赖于手术治疗。一、内科治疗溃疡性结肠炎和克隆氏病的内科治疗原则及用药大致相同。严重发作时应立即住院,给予补液、纠正脱水和电解质紊乱。在药物治疗方面,溃疡性结肠炎急性活动期的首     

对我国炎症性肠病诊断治疗规范的共识意见的解析

本文对中华医学会消化病学分会炎症性肠病协作组2007年制订的新的<对我国炎症性肠病诊断治疗规范的共识意见>中关于溃疡性结肠炎诊断和治疗部分作一解析,对<共识>出台的背景作了详细介绍,对主要修改内容及原因作说明,对临床诊治中的一些热点问题如非特异性结肠炎的命名诊断与治疗,益生菌选择,促凝止血药物应用的误区作讨论.     

血清学标志物与炎症性肠病:血清标志物盛行及对炎症性肠病诊治价值

炎症性肠病(inflammatory bowel disease, IBD)是一种由遗传因素和环境因素共同导致的累及消化道的慢性非特异性疾病,包括溃疡性结肠炎、克罗恩病和未分类炎症性肠病.目前其诊断主要依靠临床表现、影像学改变、结肠镜检以及病理活检,但是有一定局限性.血清学标志物检测法在IBD诊断中优势凸显,国内外已有大量文献报道.本文就血清学标志物与炎症性肠病诊治做一述评,旨在进一步明确其在炎症性肠病诊治中的地位.     

李军祥教授治疗溃疡性结肠炎经验

溃疡性结肠炎是一种病因尚未完全清楚的慢性非特异性炎症性肠病。李军祥教授对于溃疡性结肠炎的病因病机有深刻认识,在治疗溃疡性结肠炎方面有其独特的临床经验,并且经过多年临床摸索,创制清肠温中方,临床治疗效果明显。     

鱼油脂肪酸辅助治疗活动性溃疡性结肠炎

经环氧合酶和脂氧合酶途径生成的花生四烯酸代谢产物可引致腹泻和炎症性肠病结肠炎,特别是溃疡性结肠炎。活动性溃疡性结肠炎病人直肠粘膜的白三烯B_4水平升高,其水平与疾病的严重性相关。作者研究了口服白三烯合成抑制剂鱼油n-3-ω脂肪酸治疗溃疡性结肠炎的效果。     

溃疡性结肠炎中西医结合诊疗指南(草案)

中国中西医结合学会消化系统疾病专业委员会于1992年山西临汾和2003年重庆全国中两医结合消化学术会议上分别制定了"慢性非特异性溃疡性结肠炎中西医结合诊断、辨证和疗效标准"[1]与"溃疡性结肠炎中西医结合诊治方案"[2].近年来,溃疡性结肠炎(Ulcerative colitis,UC)在国内外研究已经取得了一些重大进展[3～8],中华医学会消化病分会于2007年济南会议公布了"对我国炎症性肠病诊断和治疗规范的共识意见"[9].     

炎症性肠病腹泻发生机制及处理原则

炎症性肠病(IBD),无论是溃疡性结肠炎(UC),还是克罗恩病(CD),在我国发病率日趋增加.IBD临床表现纷繁复杂,但腹泻为其最常见的症状,发生率达70%～90%.由于腹泻的程度和性状与肠道炎症的程度和范围密切相关,常被作为IBD活动指数(DAI)与严重指数(DSI)的重要指标来判断疾病活动性、严重度与治疗反应.因此充分认识腹泻发生的机制和临床特点,极有利于提高疾病的诊治水平.     

溃疡性结肠炎的分期治疗

溃疡性结肠炎(ulcerative colitis,UC)是临床上常见的消化系统疑难病,治愈率低,易复发。研究证实,UC患者患结直肠癌、强迫症、恐慌症、抑郁症和焦虑症的概率较高,给生活带来了较大的困扰[1-2]。以往该病在北美和欧洲多见,近年来,我国UC的发病率呈上升趋势[3],但目前为止其确切的发病原因及机制尚不明确,因此治疗上只能控制急性发作,减缓疾病进程,减少并发症,使患者长期维持在缓解期,以提高生活质量,避免再次住院[4]。     

Appendix adenocarcinoma associated with ulcerative colitis: a case report and literature review

Ulcerative colitis (UC) represents a risk factor for colorectal cancer, but the association between UC and appendix cancer is uncommon. A 60–year–old woman with a 5–year history of UC initially received medical treatment with mesalazine and prednisone with no satisfactory response; therefore surgery was indicated. The procedure was a total intersphincteric proctocolectomy with ileostomy. Histopathological analysis indicated adenocarcinoma from the cecal appendix, and chronic–active ulcerative colitis of the colon. In conclusion, surgeons and pathologists should examine every surgical specimen from patients with UC because of the possibility, although remote, of a neoplasic pathology. The appendix adenocarcinoma and ulcerative colitis may or may not be associated, same as colon cancer in patients with UC.     

营养治疗对溃疡性结肠炎肠道免疫屏障的疗效

溃疡性结肠炎（UC）是原因不明的非特异性结肠炎症性疾病,目前认为肠道免疫功能失调是溃疡性结肠炎发病的根本原因,针对肠道免疫功能失调的治疗是目前溃疡性结肠炎治疗研究的热点。由于药物的不良反应和使用的限制,溃疡性结肠炎的临床治疗有效率仅50％左右,并且还无有效控制复发的治疗手段。近期溃疡性结肠炎的研究发现不同形式的营养治疗不仅能够改善患者的营养状态,有些营养成分还具有调整炎症反应、改善肠道免疫屏障功能的作用。     

中国溃疡性结肠炎诊治规范的解析

溃疡性结肠炎(UC)在我国的发病率呈上升趋势,严重危害人民健康。迄今我国已发布4版UC诊断治疗规范,这些版本在涉及UC诊断治疗的各个方面均出现了较大的变化,体现了我国消化内科在UC诊治过程中对该病的理解不断深入、诊疗手段逐渐丰富方面,取得了长足的进步和发展,但我国UC的外科治疗与发达国家相比存在较大差距,包括手术指征、手术时机和术式规范等多个方面。本文从诊断标准、诊断内容、疗效标准和治疗建议等方面对我国UC诊治规范的演变进行解读分析,并针对我国UC的临床现状进行总结,对未来的发展趋势和工作方向进行展望。     

Topische Therapie bei chronisch-entzündlichen Darmerkrankungen

Ulcerative colitis is a disease with increasing incidence and prevalence in the western world and also in developing countries. The mainstay of therapy is 5 aminosalicylic acid (5-ASA). Frequently only oral therapy is used in patients with ulcerative colitis (UC); however, there is excellent evidence that topical (rectal) therapy is more effective than oral/systemic therapy especially in left sided colitis. In general, data from cohort studies and center-based investigations indicate that topical therapy is underused in patients with UC. A combination of oral and topical rectal therapy is usually preferable, especially in severe colitis. This review aims to clarify the evidence for topical therapies containing 5-ASA and steroids for patients with ulcerative colitis for an optimization of therapy with satisfying compliance. Patient acceptance of topical therapies is much better after adequate information than generally expected. The evidence for topical therapies in Crohn’s disease is weak.     

Topische Therapie bei chronisch-entzündlichen Darmerkrankungen

Ulcerative colitis is a disease with increasing incidence and prevalence in the western world and also in developing countries. The mainstay of therapy is 5 aminosalicylic acid (5-ASA). Frequently only oral therapy is used in patients with ulcerative colitis (UC); however, there is excellent evidence that topical (rectal) therapy is more effective than oral/systemic therapy especially in left sided colitis. In general, data from cohort studies and center-based investigations indicate that topical therapy is underused in patients with UC. A combination of oral and topical rectal therapy is usually preferable, especially in severe colitis. This review aims to clarify the evidence for topical therapies containing 5-ASA and steroids for patients with ulcerative colitis for an optimization of therapy with satisfying compliance. Patient acceptance of topical therapies is much better after adequate information than generally expected. The evidence for topical therapies in Crohn’s disease is weak.     

Guidelines for the management of ulcerative colitis

Ulcerative colitis (UC) is a chronic inflammatory bowel disorder characterized by a relapsing and remitting course. The quality of life can decreases significantly during exacerbations of the disease. The incidence and prevalence of UC in Korea are still lower than those of Western countries, but have been rapidly increasing during the past decades. Various medical and surgical therapies are currently used for the management of UC. However, many challenging issues exist and sometimes these lead to differences in practice between clinicians. Therefore, Inflammatory Bowel Diseases (IBD) Study Group of Korean Association for the Study of Intestinal Diseases (KASID) set out the Korean guidelines for the management of UC. These guidelines are made by the adaptation using several foreign guidelines and encompass treatment of active colitis, maintenance of remission and indication for surgery in UC. The specific recommendations are presented with the quality of evidence. These are the first Korean treatment guidelines for UC and will be revised with new evidences on treatment of UC.     

克罗恩病术后治疗和溃疡性结肠炎手术时机的抉择

炎症性肠病(IBD)包括克罗恩病(CD)和溃疡性结肠炎(UC),是一种肠道慢性非特异性炎症性疾病。尽管治疗IBD的药物层出不穷,但仍有部分患者需行手术治疗。CD的术后治疗和UC手术时机的选择对患者的生活质量的提高以及预后非常重要。本文就CD的术后治疗和UC手术时机的选择作一简单概述。     

Efficacy and safety of Shenling Atractylodes Powder in the treatment of ulcerative colitis: A protocol for systematic review and meta-analysis

Background:Ulcerative colitis (UC) is a kind of chronic non-specific ulcerative colitis, which is characterized by repeated abdominal pain, diarrhea, and mucus purulent stool. The disease is more recurrent, easy to delay, and canceration, seriously affect the quality of life, increase the economic burden of patients and society, treatment is more difficult, the World Health Organization as one of the modern refractory diseases. Shenling Atractylodes Powder in the treatment of ulcerative colitis showed a strong advantage, the effect is accurate. Therefore, this paper will systematically evaluate and meta-analyze the efficacy and safety of heat-sensitive moxibustion in the treatment of ulcerative colitis.Methods:Eight electronic databases were searched, including the PubMed, Embase, Web of Science, Cochrane Library, China National knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and China Biomedical Literature Database. We will search in the above electronic database from early 2021 to December without any language restrictions. Outcome indicators, including colonic mucosal symptom score Mayo colonoscopy grading, total effective rate, total incidence of adverse reactions, clinical symptom score, recurrence rate, laboratory indicators: IL-6, IL-9, TNF-α, IL-4, IL-10 inflammation-related factor levels. Rev Man5.3 software will be used for statistical analysis. The efficacy and safety results of Shenling Atractylodes Powder in the treatment of ulcerative colitis will be used as the average difference between the risk ratio of dichotomy data and the 95% co-card interval of continuous data.Results:When this research program is completed, the relevant results can be obtained.Ethics and dissemination:This article does not need to pass the ethics committee review, because this article does not involve the ethics question, only collates the related literature research. The results of this study will be disseminated in the form of a paper to help better guide the clinical practice of heat-sensitive moxibustion in the treatment of ulcerative colitis.Registration Number:INPLASY202120018.