Shen Bo
Pouchitis Clinic, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Inflamm Bowel Dis. 2009 Feb;15(2):284-94. doi: 10.1002/ibd.20661.
Restorative proctocolectomy with ileal pouch-anal anastomosis has become the surgical treatment of choice for patients with ulcerative colitis or indeterminate colitis who require surgery. A subset of patients with ileal pouches may develop Crohn's disease or a Crohn's disease-like condition of the pouch after the surgery. Diagnosis, differential diagnosis, and management can be challenging. A combined assessment of endoscopy, histology, radiography, and examination under anesthesia is often necessary for an accurate diagnosis. A multidisciplinary approach by a medical and surgical team is advocated. It is advisable to inform ulcerative colitis patients before the surgery of the potential risk for Crohn's disease along with other inflammatory and noninflammatory complications.
回肠储袋肛管吻合术的全直肠系膜切除术已成为需要手术治疗的溃疡性结肠炎或不确定性结肠炎患者的首选手术方式。一部分接受回肠储袋手术的患者术后可能会发生克罗恩病或储袋的类克罗恩病情况。诊断、鉴别诊断及处理颇具挑战性。通常需要综合内镜检查、组织学检查、放射学检查及麻醉下检查以做出准确诊断。提倡由内科和外科团队采用多学科方法。建议在手术前告知溃疡性结肠炎患者存在克罗恩病以及其他炎性和非炎性并发症的潜在风险。
