平肠汤治疗慢性复发型溃疡性结肠炎的临床观察

目的:观察自拟平肠汤治疗慢性复发型溃疡性结肠炎 (UC)的疗效及安全性。方法:选取 2017年 12月—2019年 8月西南医科大学附属医院诊治的 120例 UC患者,随机分为观察组(口服平肠汤)和对照组(口服美沙拉嗪)各 60例。两组患者均连续治疗 8周,疗程结束后随访 6个月。比较两组的临床疗效、改良 Mayo评分、主要临床症状积分、结肠镜评分及生存质量。采用酶联免疫吸附法检测两组患者治疗前后的肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6及 IL-10表达水平变化,观察两组复发情况及不良反应。结果:治疗后,观察组临床总有效率(89%)明显优于对照组(73%),复发率(14%)低于对照组(31%),差异有统计学意义(P＜ 0.05)。观察组的改良 Mayo评分(1.89±0.79)、主要临床症状积分(1.72±0.56)、Baron评分(1.37±0.49)均较前明显下降,且低于对照组 [分别为(2.22±0.71)、(2.02±0.68)、(1.60±0.49)],差异有统计学意义(P＜ 0.05)。治疗后,两组 TNF-α、IL-6表达水平均下调,观察组低于对照组; IL-10表达水平上调,且观察组高于对照组,差异有统计学意义(P＜ 0.05)。治疗后,两组生存质量 IBDQ评分均较前明显改善,且观察组治疗后的生存质量更优于对照组,差异有统计学意义(P＜ 0.05)。治疗期间观察组无不良反应,对照组出现 2例不良反应。结论:自拟平肠汤治疗慢性复发型 UC疗效显著且安全性高,其主要通过下调炎症介质表达水平有效抑制炎症反应,促进黏膜愈合,明显改善 UC患者临床症状及生存质量,并减少复发。     

微生态制剂对危重病患者胃肠功能障碍的治疗作用

目的研究微生态制剂（金双歧）对危重病患者胃肠功能障碍恢复的治疗作用及多器官功能障碍综合征（MODS）的防治。方法96例ICU胃肠功能障碍的危重病患者,分为两组：金双歧治疗组（56例）,对照组（40例）,观察两组患者胃肠功能评分、Marshall评分、APACHEⅡ评分、MODS的发生率与病死率。结果金双歧治疗组治疗后胃肠功能评分、APACHEⅡ评分及Marshall评分均有所降低,MODS的发生率和病死率均与对照组差异有统计学意义（P〈0．01）。结论微生态制剂对危重病患者胃肠功能障碍具有较好的治疗作用,可明显降低MODS的发生率和病死率。     

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…     

红细胞沉降率联合白细胞介素-6水平检测对溃疡性结肠炎患者临床疗效的评估价值

目的:探讨红细胞沉降率(ESR)联合白细胞介素-6(IL-6)对溃疡性结肠炎患者临床疗效的评估价值。方法:选取2021年1月至2022年10月我院收治的78例溃疡性结肠炎患者，根据病情严重程度分为轻度组54例、中度组34例和重度组20例，比较3组患者ESR、IL-6水平，采用Spearman相关性分析溃疡性结肠炎患者ESR、IL-6水平与病情严重程度的关系，采用受试者工作曲线(ROC)分析ESR,IL-6水平对溃疡性结肠炎患者临床疗效的评估价值。结果:不同病情严重程度患者ESR、IL-6水平比较差异均有统计学意义(P<0.05),重度组患者ESR、IL-6水平均高于中度组和轻度组(P<0.05),且中度组患者ESR、IL-6水平均高于轻度组(P<0.05),Spearman相关性分析显示，ESR、IL-6水平均与溃疡性结肠炎患者病情严重程度呈正相关(r=0.574,r=0.435,P<0.001)。溃疡性结肠炎患者经柳氮磺吡啶片(3.0～4.0 g/d)、静脉点滴氢化可的松或口服强的松等药物治疗1～2个月后，病情均得到缓解。ROC分析显示，ESR、IL-6水平对...     

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现状

溃疡性结肠炎（ulcerative colitis，UC）又称非特异性溃疡性结肠炎，是炎症性肠病（inflammatory bowel disease，IBD）中的一种。其发病机理迄今尚未完全明确，临床症状以黏液脓血便、腹痛、腹泻或里急后重为主，多反复发作迁延数月、数年乃至数十年。现就有关UC的治疗现状作一介绍。     

溃疡性结肠炎的中医药治疗

溃疡性结肠炎（ulcerative colitis，UC），又称非特异性溃疡性结肠炎，是一种发病原因尚不明确的慢性直肠和结肠炎症性疾病。近年来，中医药在本病的治疗上显示出了优势，并积累了丰富的经验，且具有疗效稳定、无毒副作用等特点，现将中医学近几年来有关本病的治疗研究综述如下。     

淫羊藿对大鼠溃疡性结肠炎的治疗机制研究

目的:观察淫羊藿对大鼠溃疡性结肠炎的治疗效果以及对结肠组织中相关炎症因子表达的影响。方法:雄性SD大鼠84 只,随机分为空白对照组、模型组、淫羊藿高、中、低剂量组、柳氮磺吡啶(SASP)组及联合治疗组,每组12 只。采用疾病活动指数(DAI)、结肠大体损伤评分、结肠组织病理学评分、结肠组织TNF-α、IFN-γ 和IL-6 免疫组化表达情况评价其治疗作用。结果:在实验处理第4 天开始,各实验组大鼠与模型组比较体重增加,实验第7 天联合组大鼠与SASP组比较体重增加,且差异均有统计学意义(P <0.05);第5 天开始各实验组与模型组比较,DAI 评分升高,差异有统计学意义(P <0.05);各实验组结肠损伤程度与模型组比较,联合组的结肠溃疡面积及结肠重量与长度比减小,淫羊藿高、中、低剂量组及联合组的结肠损伤程度减轻,联合组的结肠溃疡面积小于SASP 组,差异均有统计学意义(P <0.05);与模型组比较,淫羊藿高剂量组结肠组织病理学评分显著降低(P <0.01);各实验组大鼠结肠组织中TNF-α、IFN-γ 和IL-6 表达水平,联合组及SASP 组与模型组比较显著降低(P <0.01),联合组较SASP 组显著降低(P <0.01)。结论:淫羊藿可改善溃疡性结肠炎大鼠的精神状态、减轻结肠损伤程度,其治疗作用可能与其减少TNF-α、IFN-γ 和IL-6 细胞因子表达有关。     

微生态制剂在小儿腹泻治疗中的临床价值研究

目的：研究微生态制剂在小儿腹泻治疗中的临床价值。方法选取2011年8月~2013年9月我院收治的小儿腹泻患者80例,随机分为观察组和对照组,对照组给予思密达治疗,观察组给予微生态制剂治疗,观察两组患儿的腹泻情况和机体炎症情况。结果观察组患儿的腹泻次数,腹痛缓解时间均比对照组少,炎症指标IL-1、IL-6、C反应蛋白水平均低于对照组。结论微生态制剂治疗有助于控制腹泻症状、缓解炎症反应,是治疗小儿腹泻的理想方法。     

红藤汤对小鼠溃疡性结肠炎的保护作用及机制探究

目的:观察红藤汤对葡聚糖硫酸钠(dextran sulphate sodium,DSS)诱导的溃疡性结肠炎小鼠的抗炎和抗氧化作用,分析红藤汤对溃疡性结肠炎的保护机制。方法:SPF级BALB/c小鼠30只,随机分成3组(n=10):对照组(C组)、DSS诱导的溃疡性结肠炎模型组(M组)、红藤汤治疗组(H组)。C组自由饮水,M组和H组采用自由饮用4%的DSS建立溃疡性结肠炎模型,H组从造模第1天起开始给药,连续给药10天后,采集动脉血检测TNF-α和IL-6的浓度,行结肠组织病理学评分,比色法测定MDA量及SOD和GSH-Px活性,Western blotting检测ERK1/2、P-ERK1/2、JNK、P-JNK及GADPH蛋白的表达量。结果:与M组比较,H组的结肠病理学评分和血清中炎症因子(TNF-α和IL-6)含量显著降低(P<0.05);结肠组织中MDA的含量降低(P<0.05),而SOD和GSH-Px活性升高(P<0.05),P-ERK1/2和P-JNK的表达水平也明显下调(P<0.05)。结论:红藤汤对DSS诱导的小鼠溃疡性结肠炎有保护作用,可以上调抗氧化基因,减少自由基的生成,重建氧化还原平衡,其作用机制可能与抑制JNK和ERK1/2信号通路的活化,减少炎症因子生成有关。     

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目的 探讨溃疡性结肠炎及其并发症的治疗方式。方法 回顾性分析108例溃疡性结肠炎病人的临床资料。结果 轻、中型溃疡性结肠炎采用药物保留灌肠和口服药物治疗,缓解率达88.9%,但73.1%的病例呈周期性发作,并发症的治疗包括;息肉电凝摘除。结肠大部分切除,回肠造口,全结肠直肠切除,回肠造口,全结肠直肠切除,回肠贮袋肛管吻合（IPAA）等术式,全组病例无严重并发症和死亡,效果良好。结论 轻、中型溃疡性结肠炎应以药治疗为主,其并发症的治疗应采用外科治疗。全结肠切除,回肠造口术及结肠大部分切除。回肠造口术仍为较安全的手术方式,但亦给病人带来生活上的不便。故保肛手术应受推崇。     

美沙拉嗪联合奥硝唑治疗溃疡性结肠炎的疗效观察

目的：探讨美沙拉嗪联合奥硝唑治疗溃疡性结肠炎的疗效。方法80例溃疡性结肠炎患者随机分为观察组（美沙拉嗪联合奥硝唑治疗）和对照组（美沙拉嗪治疗）各40例。连用8周,比较两组的临床疗效及治疗前后DAI的变化。结果治疗8周后,观察组患者的总有效率95.0%,明显高于对照组77.5%（x2=4.973, P＜0.05）。治疗前两组DAI比较,差异无统计学意义（P＞0.05）。治疗8周后,两组患者的DAI 明显均较治疗前明显降低（t=2.37、2.89,P＜0.05）,且观察组DAI较对照组降低更显著（t=2.972,P＜0.05）。结论美沙拉嗪联合奥硝唑治疗溃疡性结肠炎疗效确切,安全性好,可以明显改善患者的临床症状,值得推广和应用。     

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.     

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。     

神经激肽 1受体在溃疡性结肠炎组织的表达和临床意义

目的 了解P物质受体-神经激肽1受体（NK-1R）在正常肠管和溃疡性结肠炎组织中的表达，探讨该受体在溃疡性结肠炎的病理生理过程中所起的作用。方法 21个溃疡性结肠炎标本取自因该病并发症而手术的患。正常肠管组织取自24个器官捐献，应用逆转录聚合酶链反应（RT-PCR）技术检测正常肠管和溃疡性结肠炎组织NK-1R的信使核糖核酸（mRNA)水平，应用Western blot技术检测NK-1R的蛋白水平，应用免疫组织化学方法（免疫组化）进行NK-1R的组织学定位。结果 与正常肠管相比，溃疡性结肠炎组织中NK-1RmRNA和蛋白都过度表达，免疫组化检查显示，NK-1R的表达主要位于溃疡性结肠炎组织的肠黏膜表面，黏膜固有层的单核细胞，黏膜下层的动，静脉和纵形与环形肌层等处。结论 溃疡性结肠炎组织中NK-1R的表达水平明显上调，扰乱了神经激肽的作用环节，加剧肠管的病理改变。     

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     

Immunoglobulin A nephropathy complicating ulcerative colitis

Ulcerative colitis is rarely associated with immunoglobulin A nephropathy (IgAN). The development of IgA nephropathy complicates further the clinical course of patients with ulcerative colitis. A 72-year old man with a 30-year history of ulcerative colitis requiring colectomy and modest renal insufficiency secondary to complications of nephrolithiasis and renal artery stenosis developed glomerular hematuria, proteinuria and progressive renal failure. Percutaneous kidney biopsy revealed IgAN with extensive glomerular and interstitial sclerotic changes. After resection of a chronically infected ileo-rectal pouch, renal function improved, while hematuria and proteinuria gradually disappeared without specific treatment of the IgAN. The manifestations of IgAN complicating ulcerative colitis can be improved with effective treatment of the bowel disease even when there are extensive sclerotic changes in the kidneys.     

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。     

Discontinuous appendiceal involvement in ulcerative colitis: Pathology and clinical correlation

Continuous mucosal involvement from the rectum proximally is one of the hallmarks of ulcerative colitis. However, recent pathologic series report appendiceal ulcerative colitis in the presence of a histologically normal cecum, representing a "skip" lesion. The clinical significance of this rinding has not been established. Eighty patients, 54 males and 26 females, average age 37.9 years (range 14 to 82 years) who underwent proctocolectomy for ulcerative colitis from January 1990 to September 1995 were examined to determine the rate of discontinuous appendiceal involvement. Excluded were 12 patients with prior appendectomy and 11 with fibrotic obliteration of the appendiceal lumen. Of the remaining 57 patients, seven (12.3%) had clear appendiceal involvement in the presence of a histologically normal cecum. These seven patients clinically were indistinguishable from the 50 patients without skip involvement of the appendix in terms of age at surgery, pretreatment medications, type of surgery, interval from diagnosis to definitive procedure, complications, functional results, and clinical course. Discontinuous appendiceal involvement was found in 12.3% of patients undergoing proctocolectomy for ulcerative colitis, and clinically these patients behave as those without this feature.