Derikx Lauranne A A P, Heikens Joost T, van Laarhoven Cornelis J H M, Hoentjen Frank
UMC St Radboud, Nijmegen.
Ned Tijdschr Geneeskd. 2013;157(39):A5553.
The surgical treatment of choice for ulcerative colitis is colectomy followed by ileostomy or the construction of an ileo-anal pouch, which results in an improvement in quality of life. The pouch can be constructed in one operation after a total colectomy or in two steps: first, constructing an ileostomy after a subtotal colectomy and second, constructing the pouch after a proctectomy. The most common pouch-related diseases include surgical complications such as abscesses, fistulas and leaks, and inflammatory complications like pouchitis, cuffitis and Crohn's disease of the pouch. The most important diagnostic tool to differentiate between the often difficult to distinguish pouch-related diseases is a pouchoscopy. There are no evidence-based treatment strategies for pouch-related diseases due to the lack of large randomized placebo-controlled trials. Pouch-related diseases can lead to pouch failure which may require surgical reintervention with revision or excision of the pouch.
溃疡性结肠炎的首选手术治疗方法是结肠切除术，随后进行回肠造口术或构建回肠肛管袋，这会使生活质量得到改善。该袋可在全结肠切除术后一次性手术构建，也可分两步进行：首先，在次全结肠切除术后构建回肠造口术，其次，在直肠切除术后构建该袋。最常见的与袋相关的疾病包括手术并发症，如脓肿、瘘管和渗漏，以及炎症性并发症，如袋炎、袖口炎和袋的克罗恩病。区分通常难以辨别的与袋相关疾病的最重要诊断工具是袋内镜检查。由于缺乏大型随机安慰剂对照试验，目前尚无基于证据的与袋相关疾病的治疗策略。与袋相关的疾病可导致袋功能衰竭，这可能需要通过对袋进行修复或切除的手术再次干预。
