Kroesen A J
Allgemein- und Viszeralchirurgie, Krankenhaus Porz am Rhein, Urbacher Weg 19, 51149, Köln, Deutschland,
Chirurg. 2015 Apr;86(4):332-7. doi: 10.1007/s00104-014-2850-7.
After colorectal and anorectal interventions for chronic inflammatory bowel diseases, specific complications can occur.In Crohn's disease these complications mainly occur after proctocolectomy. Pelvic sepsis can be prevented by omentoplasty with fixation inside the pelvis. A persisting sepsis of the sacral cavity can be treated primarily by dissection of the anal sphincter which ensures better drainage. In cases of chronic sacral sepsis, transposition of the gracilis muscle is a further effective option. Early recurrence of a transsphincteric anal fistula should be treated by reinsertion of a silicon seton drainage.Complications after restorative proctocolectomy are frequent and manifold (35%). The main acute complications are anastomotic leakage and pelvic sepsis. Therapy consists of transperineal drainage of the abscess with simultaneous transanal drainage. Late complications due to technical and septic reasons are still a relevant problem even 36 years after introduction of this operative technique. A consistent approach with detailed diagnostic and surgical therapy results in a 75% rescue rate of ileoanal pouches.
在对慢性炎症性肠病进行结直肠和肛门直肠干预后，可能会出现特定并发症。在克罗恩病中，这些并发症主要发生在直肠结肠切除术后。盆腔脓毒症可通过在盆腔内固定的网膜成形术来预防。骶腔持续脓毒症可首先通过解剖肛门括约肌进行治疗，这能确保更好的引流。对于慢性骶腔脓毒症病例，股薄肌转位是另一种有效的选择。经括约肌肛瘘的早期复发应通过重新插入硅胶挂线引流进行治疗。保留肛门的直肠结肠切除术后并发症频繁且多样（35%）。主要的急性并发症是吻合口漏和盆腔脓毒症。治疗包括经会阴脓肿引流并同时经肛门引流。即使在引入这种手术技术36年后，由于技术和感染原因导致的晚期并发症仍然是一个相关问题。采用一致的方法并进行详细的诊断和手术治疗，回肠肛管袋的挽救率可达75%。
