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。

Surgical treatment of ulcerative colitis: a clinical experience in 15 cases

Objective:To summarize the clinical experience of the operative treatment for ulcerative colitis (UC). Methods:The clinical data of 15 cases of UC undergoing surgery were retrospectively analyzed.Results:In this study,15 cases of UC patients were treated by surgery,in whom failure to control symptoms by conservative treatment in 9 cases,bowel obstruction in 3 cases,suspected malignancy in 3 cases.7 patients underwent total proctocolectomy and ileostomy,4 patients with total proctocolectomy and ileal anal anastomosis (IPAA),2 pa- tients with total colectomy and ileorectal anastomosis,and 2 patients with partial colectomy.Conclusion:The main indications for surgery in UC patients were failure of medical treatment,complicated by bowel obstruction and sus- pected malignancy.Total proctocolectomy and ileostomy is a cure for UC,total proctocolectomy and ileal pouch-a- nal anastomosis improves defecation control but followed by a high incidence of stomal ulcer.The stoma fistula could be cured by continual presacral irrigation.