Ackermann C, Tondelli P
Chirurgische Abteilung, St. Claraspital, Basel.
Ther Umsch. 1991 Jul;48(7):471-9.
Ulcerative colitis can be cured by surgical therapy. Indications for surgery are severe disease not controlled by medical therapy, complication of colitis and prophylaxis of malignancy. Operation of choice is proctocolectomy and ileoanal anastomosis with pelvic ileal pouch, preserving continence. Alternatives are colectomy and ileo-recto-anastomosis if the rectum is free of disease and proctocolectomy with ileostomy if the rectum is involved. Crohn's disease cannot be cured by surgery. Indications for surgery are obstructing or perforating complications of enterocolitis. Basis of surgical therapy is resection, which should be restricted to the severely diseased bowel segment. Structureplasty can correct short bowel stenosis without resection. Surgery for anal Crohn's disease should be limited to drainage of septic complications. Postoperative results support a tendency towards early surgery in ulcerative colitis, while surgery in Crohn's disease should be reserved for severe and complicated disease.
溃疡性结肠炎可通过手术治疗治愈。手术指征为药物治疗无法控制的重症疾病、结肠炎并发症以及恶性肿瘤的预防。首选手术方式是全直肠结肠切除术及带盆腔回肠贮袋的回肠肛管吻合术，以保留控便能力。若直肠无病变，可选择结肠切除术及回肠直肠吻合术；若直肠受累，则选择全直肠结肠切除术及回肠造口术。克罗恩病无法通过手术治愈。手术指征为小肠结肠炎的梗阻或穿孔并发症。手术治疗的基础是切除，应仅限于病变严重的肠段。整形手术可在不切除的情况下纠正短肠狭窄。肛门克罗恩病的手术应仅限于处理感染性并发症的引流。术后结果支持溃疡性结肠炎倾向于早期手术的趋势，而克罗恩病的手术应仅用于重症和复杂疾病。
