重症溃疡性结肠炎的外科治疗策略
Surgical strategies of critical ulcerative colitis
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摘要:
溃疡性结肠炎(UC)的外科治疗日益得到重视，全结直肠切除+回肠贮袋肛管吻合术已成为标准手术方式。急性重度UC是治疗的难点，常用策略为激素治疗观察后再决定是否行转化治疗，而其中重症UC(CUC)由于病情危重，常合并凶险性大出血、中毒性巨结肠或结肠穿孔等，其处理更加紧迫和复杂，因此对于外科手术和围术期管理要求更高。目前外科医师在面对CUC时，应采用何种外科策略尚缺乏统一规范，结合文献资料和临床体会，笔者对CUC的外科手术时机、手术方式和术后管理等方面进行梳理，探讨外科治疗改善CUC患者预后的价值。
Abstract:Surgical treatment of ulcerative colitis (UC) has received increasing attention. Total proctocolectomy with ileal pouch anal anastomosis (IPAA) has become a stan dard procedure. Acute severe UC (ASUC) is a difficult point of treatment. The commonly used strategy is to determine whether conversion therapy is performed after the observation of hormone therapy. Critical UC (CUC) is more urgent and complex due to the critical condition of the disease, which is often combined with uncontrollable massive hemorrhage, toxic megacolon or colonic perforation. Therefore, higher requirements for surgical and perioperative management are necessary. At present, when surgeons face CUC patients, what surgical strategy should be adopted is still lack of unified standard. The authors intended to sort out the timing, operation procedure and postoperative management of CUC so as to give full play to the value of surgical treatment and to improve the prognosis of CUC patients.
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Keywords:
- Critical ulcerative colitis /
- Surgery /
- Therapy /
- Operation timing /
- Ileal pouch anal anastomosis
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