Third General Surgery Unit, Istituto Clinico Humanitas IRCCS, Università degli Studi di Milano, via Manzoni 56, 20089, Rozzano Milan, Italy.
Curr Drug Targets. 2011 Sep;12(10):1462-6. doi: 10.2174/138945011796818199.
Ulcerative colitis (UC) is a chronic inflammatory condition of the mucosa affecting the rectum and extending up the colon in a continuous manner. Its etiology is unknown, but is most probably the result of the interaction of genetic and environmental factors. Approximately 30% of UC patients will need to undergo surgery at some point during their lifetime, despite progresses made in medical therapies. Indications for surgery include acute severe colitis with its complications, steroid-or antiTNF-refractory colitis (or growth impairment in children), and the onset of colorectal dysplasia/cancer. Recently, the introduction of biologic agents has provided a rationale for prolonging medical therapy before considering surgery in the treatment of active, moderate to severe colitis. When surgery becomes indicated, especially in the urgent setting, it usually involves dealing with immunosuppressive medications, possibly impacting the onset of post-operative septic complications. In both acute and chronic settings, patients should be informed about the medical and surgical options and their respective prognoses; the crucial decision regarding the timing for surgery should be shared by both gastroenterologists and colorectal surgeons. The aim of the present review is to highlight surgical indications and options for UC patients as well as the evidence about surgical complications following medical therapies, in order to aid clinicians in determining the best timing for surgery.
溃疡性结肠炎（UC）是一种直肠和结肠连续黏膜的慢性炎症性疾病。其病因不明，但极有可能是遗传和环境因素相互作用的结果。尽管在医学治疗方面取得了进展，但大约 30%的 UC 患者在其一生中的某个时候需要接受手术。手术的指征包括伴有并发症的急性重度结肠炎、激素或抗 TNF 难治性结肠炎（或儿童生长障碍）以及结直肠异型增生/癌症的发生。最近，生物制剂的引入为在治疗活动期、中重度结肠炎时考虑手术之前延长药物治疗提供了依据。当手术成为指征时，特别是在紧急情况下，通常需要处理免疫抑制药物，这可能会影响术后感染性并发症的发生。在急性和慢性情况下，应告知患者有关药物和手术的选择及其各自的预后；手术时机的关键决策应由胃肠病学家和结直肠外科医生共同做出。本综述的目的是强调 UC 患者的手术适应证和选择，以及药物治疗后手术并发症的证据，以帮助临床医生确定手术的最佳时机。
