Li Y, Zhu H, Shen B
Department of Gastroenterology, Peking Union Medical College, Beijing, China.
Minerva Gastroenterol Dietol. 2012 Jun;58(2):123-35.
Approximately 20-30% of patients with ulcerative colitis would eventually require surgery despite recent advances in medical therapy. Ileal pouch-anal anastomosis has become the surgical treatment of choice after total proctocolectomy. A subset of patients who had a preoperative diagnosis of ulcerative colitis may develop Crohn's disease or a Crohn's disease-like condition of the ileal pouch after surgery. Diagnosis, differential diagnosis, and management of Crohn's disease of the ileal pouch have been challenging. A combined approach with the assessment of clinical history, endoscopy, histology, abdominal/pelvic imaging, and examination under anesthesia is necessary for an accurate diagnosis, disease classification, management and improvement in outcome. A multidisciplinary approach with gastroenterologists, colorectal surgeons, gastrointestinal pathologists and radiologists for proper medical, endoscopic, and surgical treatment is advocated.
尽管近年来药物治疗取得了进展，但约20%-30%的溃疡性结肠炎患者最终仍需要手术治疗。回肠贮袋肛管吻合术已成为全直肠结肠切除术后的首选手术治疗方式。一部分术前诊断为溃疡性结肠炎的患者术后可能会发生克罗恩病或回肠贮袋的克罗恩病样病变。回肠贮袋克罗恩病的诊断、鉴别诊断及管理颇具挑战性。准确诊断、疾病分类、管理及改善预后需要结合临床病史评估、内镜检查、组织学检查、腹部/盆腔影像学检查及麻醉下检查。提倡由胃肠病学家、结直肠外科医生、胃肠道病理学家及放射科医生采用多学科方法进行恰当的药物、内镜及手术治疗。
