Björck S, Dahlström A, Johansson L, Ahlman H
Department of Surgery, Lundby Hospital, Göteborg, Sweden.
Agents Actions. 1992;Spec No:C60-72.
A new paradigm for the treatment of ulcerative colitis has recently been presented: Treatment of the mucosa with lidocaine (2%) enemas for prolonged periods. This therapy was introduced based on the hypothesis that hyperreactive autonomic nerves may play a pathogenetic role in the disease. One hundred consecutive patients have now been treated and the results presented. The proctitis patients all responded to the treatment, despite previous therapeutic failures in more than two-thirds of the cases. They were treated for 3-12 weeks, but 68% had a relapse (observation period 20 months). Of the 49 patients with proctosigmoiditis, two-thirds had chronic symptoms resistant to previous therapy. One of these patients did not respond to lidocaine, but developed fulminant total colitis. The other patient had therapeutic failure with lidocaine but responded well to subsequent cortisone enemas. The patients were treated until the subsets of T-lymphocytes (OKT4+ and OKT8+) disappeared from the mucosa. This occurred in parallel with symptomatic relief and eventual healing in 83% of the patients after treatment for 6-34 weeks. Of all the patients with proctosigmoiditis, 42% presented with recurrent symptoms (observation period 16 months). Of the 17 patients with left-sided colitis, all went primarily into remission within 2-4 months, but 23% had a relapse (observation period 13 months). The 6 patients with total colitis had symptomatic relief and improvement of histology when treated over 3-8 months. One patient had recurrence after 12 months. Treatment with a local anaesthetic in ulcerative colitis is a new approach to mucosal inflammation. The beneficial effects may be due to blockade of certain neural effects, such as epithelial proliferation and shedding and congestion of the mucosal vasculature, with actions on cells of the immune system.
用2%利多卡因灌肠长期治疗黏膜。该疗法是基于这样的假设引入的，即高反应性自主神经可能在该疾病中起致病作用。现已对100例连续患者进行了治疗并展示了结果。尽管超过三分之二的病例先前治疗失败，但直肠炎患者均对该治疗有反应。他们接受了3至12周的治疗，但68%出现复发（观察期20个月）。在49例直肠乙状结肠炎患者中，三分之二有对先前治疗耐药的慢性症状。其中一名患者对利多卡因无反应，但发展为暴发性全结肠炎。另一名患者利多卡因治疗失败，但随后对皮质类固醇灌肠反应良好。患者接受治疗直至黏膜中T淋巴细胞亚群（OKT4 +和OKT8 +）消失。在治疗6至34周后，83%的患者出现症状缓解并最终愈合，这与上述情况同时发生。在所有直肠乙状结肠炎患者中，42%出现复发症状（观察期16个月）。在17例左侧结肠炎患者中，所有患者在2至4个月内基本进入缓解期，但23%出现复发（观察期13个月）。6例全结肠炎患者在接受3至8个月治疗后症状缓解且组织学改善。1例患者在12个月后复发。用局部麻醉药治疗溃疡性结肠炎是一种针对黏膜炎症的新方法。其有益效果可能是由于阻断了某些神经效应，如上皮增殖、脱落以及黏膜血管充血，并对免疫系统细胞产生作用。
