Nicholls John, Mortensen Neil J, Tøttrup Anders
St. Mark's Hospital, London, England.
Ugeskr Laeger. 2011 Apr 4;173(14):1050-2.
Acute severe ulcerative colitis is a serious condition, which is initially treated with high-dose corticosteroids. Failure to obtain remission should be detected within few days after treatment start, and a decision should be made whether to proceed with either cyclosporine or biological treatment, or to move on to emergency total colectomy with ileostomy. Most patients will later be candidates for a restorative proctocolectomy. Elective indications for restorative proctocolectomy are unresponsiveness to medical treatment, growth retardation in a child/adolescent, and neoplastic transformation. Crohn's disease is increasingly being treated with immunomodulators such as corticosteroids, thiopurines and biologics. These agents play a role both in inflammatory and fistulating diseases, but surgery continues to be important in obstructive and fistulating cases. Recurrences are frequently seen after bowel resection, and cessation of smoking has been shown to lower the risk of recurrence. High risk patients can be treated with thiopurines or biologics as a prophylactic measure to delay or prevent recurrence.
急性重症溃疡性结肠炎是一种严重疾病，初始治疗采用高剂量皮质类固醇。治疗开始后数天内应检测是否未获缓解，并应决定是继续使用环孢素或生物治疗，还是进行急诊全结肠切除术并造瘘。大多数患者随后将成为恢复性直肠结肠切除术的候选者。恢复性直肠结肠切除术的择期适应症为对药物治疗无反应、儿童/青少年生长发育迟缓以及肿瘤转化。克罗恩病越来越多地采用免疫调节剂进行治疗，如皮质类固醇、硫唑嘌呤和生物制剂。这些药物在炎症性疾病和瘘管性疾病中均发挥作用，但手术在梗阻性和瘘管性病例中仍然很重要。肠道切除术后复发常见，且已证明戒烟可降低复发风险。高危患者可采用硫唑嘌呤或生物制剂作为预防性措施，以延迟或预防复发。
