*Department of Surgery, University College Hospital, London, United Kingdom; †Gastro-entérologie La Source-Beaulieu and Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; ‡Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands; and §Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Inflamm Bowel Dis. 2013 Nov;19(12):2695-703. doi: 10.1097/MIB.0b013e318292fae6.
The position of surgery in the treatment of ulcerative colitis (UC) has changed in the era of biologics. Several important questions arise in determining the optimal positioning of surgery in the treatment of UC, which has long been a challenge facing gastroenterologists and surgeons. Surgery is life-saving in some patients and leads to better bowel function and better quality of life in most patients. The benefits of surgery, however, must be weighed against the potential surgical morbidity and compromised functioning that clearly can occur. The introduction of biologic therapy has added further complexity to decisions about medical management, surgery, and the relative timing of these choices. Appropriate medical management of UC may induce and maintain remission and may prevent surgery. However, medical management also carries risks of adverse effects, and recent data suggest that delay of surgery during ineffective medical therapy can increase the chances of negative surgical outcomes. To make individualized timely treatment decisions, early collaboration between gastroenterologists and surgeons is important and more data on predictors of treatment response and positive outcomes are needed. Early identification of patients who would benefit from biologic therapy or surgery is challenging.
在生物制剂时代，手术在溃疡性结肠炎（UC）治疗中的地位发生了变化。在确定手术在 UC 治疗中的最佳定位时，出现了几个重要问题，这一直是胃肠病学家和外科医生面临的挑战。手术在某些患者中是救命的，并且在大多数患者中可以导致更好的肠道功能和更高的生活质量。然而，手术的益处必须与潜在的手术发病率和功能受损相权衡，而这些问题显然会发生。生物治疗的引入使有关医疗管理、手术以及这些选择的相对时机的决策更加复杂。UC 的适当医疗管理可以诱导和维持缓解，并可能预防手术。但是，医疗管理也有发生不良反应的风险，最近的数据表明，在无效的药物治疗期间延迟手术会增加手术不良结果的机会。为了做出个体化的及时治疗决策，胃肠病学家和外科医生之间的早期合作很重要，并且需要更多关于治疗反应和阳性结果预测因素的数据。早期识别将从生物治疗或手术中受益的患者具有挑战性。
