溃疡性结肠炎的外科治疗

溃疡性结肠炎（ｕｌｃｅｒａｔｉｖｅｃｏｌｉｔｉｓ,ＵＣ）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。近年来,我国ＵＣ病人有不断增加的倾向。ＵＣ临床特点是病程长,反复发作,可引起肠壁发生严重的病理变化,导致并发症的发生。其虽属内科疾...     

溃疡性结肠炎外科治疗进展

溃疡性结肠炎外科治疗进展甘肃省人民医院（７３０００）尹伯约，张艾莉，尹乐康，闫于悌，朱建新，党德胜溃疡性结肠炎（ＵＣ）的预后近年已有显著改善，主要归因于综合性的合理的药物治疗、适时的外科手术及静脉高营养等良好的支持疗法。本文重点讨论ＵＣ的外科治疗。１...     

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…     

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。     

溃疡性结肠炎的外科治疗

溃疡性结肠炎 (ｕｌｃｅｒａｔｉｖｅｃｏｌｉｔｉｓ ,ＵＣ)目前病因不明。现就溃疡性结肠炎外科治疗的病理基础、手术治疗和术后并发症等进行讨论。一、ＵＣ外科治疗的病理基础溃疡性结肠炎是大肠的炎性病变。最常累及直肠和乙状结肠 ,也可侵犯全部结肠甚至波及末段回肠。病变主要在粘膜及粘膜下层。病理特点为结肠粘膜广泛溃疡形成。早期结肠粘膜有广泛充血、水肿、出血、糜烂和浅表小溃疡 ,并可累及粘膜下层。溃疡可融合扩大或相互穿通形成窦道。溃疡间的粘膜增生可形成假性息肉 ,但无肉芽肿形成。肠管可因炎症及纤维化而使结肠袋消失、…     

溃疡性结肠炎的外科治疗进展

溃疡性结肠炎(ulcerativecolitis,UC)是结直肠一种原因未明的非特异性炎性疾病。1859年,Samuel Wilks首先提出这个专业名词。到了20世纪初叶,在《皇家社会医学》(RoyaSociety of Medicine)上已收集了300多例UC的报道。主要临床表现是腹泻、粘液脓血便、腹痛和里急后重,病情轻重     

溃疡性结肠炎的外科治疗

溃疡性结肠炎(ulcerative colitis—UC)发病机制至今并不明了，也缺乏决定性的针对病因的疗法。因此，虽然对症支持治疗，及激素、氨基水杨酸类、甲硝唑类等药物的广泛应用使UC病人的累计10年生存率从50年代的70％左右上升到80年代以来的95％，但仍有相当数量病人因内科疗法无效或出现严重合并症需外科治疗。据国外统计UC病史长达10年以上者手术切除率可达14%～50％。     

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。     

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。     

溃疡性结肠炎外科治疗进展

溃疡性结肠炎（Ulcerative colitis,UC）在北美和欧洲是常见病,近30年来亚洲地区的发病率也呈逐步增高趋势.我国虽然尚无完整的流行病学资料,但近十多年来本病就诊人数逐步增加的趋势非常明显,UC在我国已成为常见病,并且可能存在一定的地域分布特征.     

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。     

Current concept of pathophysiological understanding and natural course of ulcerative colitis

Introduction According to the current paradigm both ulcerative colitis (UC) and Crohns disease (CD) result from a complex interplay of genetic susceptibility factors, environmental factors, alterations of the physiological intestinal flora and a defective regulation of the intestinal immune system.Discussion The objective of this review is to give an overview of these factors and mechanisms, including genetic, environmental and microbial factors, with special alterations of relevant cellular components of the intestinal immune system such as T cells, macrophages and epithelial cells will then be addressed. In addition, the most relevant animal model systems that have contributed to our current pathogenetic understanding will be introduced. Clinically, the natural course of UC with special reference to the risk of colorectal cancer will be addressed.Conclusion The elucidation of pathomechanisms at the level of the intestinal immune system provides the potential for novel, effective treatment strategies. Best surgical management of patients with UC, however, still remains a challenge.     

The correlation between quality of life and functional outcome in ulcerative colitis patients after proctocolectomy ileal pouch anal anastomosis

Objective The aim of this study was to evaluate functional outcome and quality of life (QOL) in patients undergoing proctocolectomy ileal pouch anal anastomosis (IPAA), to assess the correlation between functional outcome and QOL, and to identify factors influencing functional outcome and QOL in these patients. Background IPAA is now considered the procedure of choice for ulcerative colitis. Functional outcome and QOL are important factors in evaluating operative outcome. Methods All patients with UC who had undergone IPAA at our institute during the period 1990–2001 were included. QOL and functional outcome were evaluated by mailed questionnaires. QOL was scored using the Short Form 36 (SF‐36). Global Assessment of Function Scale was used to evaluate functional outcome. Results Data were obtained in 77 of 99 patients (78%), with the median age of 38 years. Median follow up time was 4.25 years. The QOL in patients after pelvic pouch procedure was excellent, with scores equal to published norms for the Israeli general population in most scales. Functional outcome and QOL scores correlated strongly (r > 0.5; P < 0.0001) in all dimensions. Older age was associated with lower scores in both functional outcome and QOL scales (P < 0.0001). Conclusions This study demonstrates a strong association between functional outcome and QOL in patients after IPAA. These patients, however, have a QOL that is comparable with the general population. Age at time of surgery strongly influences both functional outcome and QOL. This finding has to be taken into consideration in pre‐operative counseling.     

溃疡性结肠炎64例临床分析

目的　进一步了解溃疡性结肠炎（ＵＣ） 的发病特点。方法　分析经肠镜、钡灌肠及各项生化检查而确诊的６４ 例ＵＣ的临床特点。结果　ＵＣ的发病以成年人多见。病变部位以左半结肠及全结肠为主，分别占４６－９ ％ 和４８－４％ ，并且后者的病情较重。体温、血沉、白细胞、血红蛋白及α２ 球蛋白与病情呈正相关。大多数患者用柳氮磺胺吡啶（ＳＡＳＰ） 治疗有效。结论　掌握ＵＣ的临床特点可正确地诊断与治疗该病。     

Role of cyclosporin in preventing or delaying colectomy in children with severe ulcerative colitis

BACKGROUND: Oral cyclosporin (CyA) has been widely and successfully used in adult patients with severe ulcerative colitis (UC) to delay or avoid colectomy. AIM: To determine if treatment with oral CyA is similarly effective in pediatric patients MATERIALS AND METHODS: Data on all patients with severe UC treated with oral CyA in our unit were collected retrospectively. Patients were treated with CyA if dependent on or resistant to steroids, and therefore, candidates for colectomy. RESULTS: Thirty-two patients with severe UC were treated with CyA administered orally at a dose needed to obtain therapeutic blood levels (150-250 ng/ml). Twenty-eight of 32 patients (87%) had an immediate response within 11 days. Four (13%) did not respond and underwent colectomy. One patient had two cycles of treatment and is in remission. Two patients underwent three cycles of treatment because of relapse, but both eventually underwent elective colectomy. Three other patients underwent elective colectomy. A total of nine colectomies were performed. CONCLUSIONS: Treatment with oral CyA altered the course of UC in 28/32 (87%) of patients; 4/32 (13%) did not respond to oral CyA and underwent colectomy. Of the 28 patients that responded to CyA, five underwent later elective colectomy. Overall, in 72% of patients, colectomy was avoided. We, therefore, suggest a trial of oral CyA in all children with severe UC who are dependent or resistant to corticosteroids.