Department of Medical and Surgical Sciences, O.U. of General Surgery, University of Catanzaro, Catanzaro, Italy; Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.
Colorectal Surgery Unit, IBD Outpatient Clinics, Catholic University of Paranà, Curitiba, Brazil.
Best Pract Res Clin Gastroenterol. 2018 Feb-Apr;32-33:71-78. doi: 10.1016/j.bpg.2018.05.017. Epub 2018 Jun 14.
Ulcerative Colitis (UC) is an idiopathic chronically-remitting inflammatory bowel disorder characterized by a contiguous inflammation of the colonic mucosa affecting the rectum that generally extends proximally in a continuous manner through the entire colon. Patients typically experience intermittent exacerbations, with symptoms characterized by bloody diarrhea associated with urgency and tenesmus. The anatomical extent of mucosal involvement is the most important factor determining disease course and is an important predictor of colectomy. The precise etiology of UC is unknown. However, a combination of genetic predisposition and environmental factors seems to have a key role in the development of the disease. UC usually is mildly active but it can be a life-threatening condition because of colonic and systemic complications, and later in the disease course due to the development of colorectal cancer. Interestingly, even if pathogenetic features detected in patients with sporadic CRC can be also found in UC-related colorectal cancer (UC-CRC), this latter is, usually, driven by an inflammation-driven pathway rising from a non-neoplastic inflammatory epithelium to dysplasia to cancer. Thus, a long-term follow-up with colonoscopy surveillance has been recommended. Approximately 15% of UC patients develop an acute attack of severe colitis, and 30% of these patients require colectomy. The initial treatment strategy in UC typically follows the traditional step-up approach. One third of the patients will not respond to steroid therapy and cyclosporine and infliximab are the most common salvage agents employed in these cases in order to avoid emergent surgery. Unfortunately, although a significant short-term benefit have been observed after infliximab treatment, the colectomy rate have remained stable. Surgery in UC depends on the stage of the disease as well as patient's status and is divided into the following settings: urgent, emergent and elective. Despite many efforts the surgical management of UC remains a significant challenge. A multidisciplinary management of UC is key in order to define the best timing and the best procedure for each patient in an individualized basis.
溃疡性结肠炎（UC）是一种特发性慢性缓解性炎症性肠病，其特征为直肠的连续炎症，通常以连续方式向近端延伸至整个结肠。患者通常会间歇性恶化，症状表现为伴有紧迫感和里急后重的血性腹泻。黏膜受累的解剖范围是决定疾病过程的最重要因素，也是结肠切除术的重要预测指标。UC 的确切病因尚不清楚。然而，遗传易感性和环境因素的结合似乎在疾病的发展中起着关键作用。UC 通常处于轻度活动状态，但由于结肠和全身并发症，以及疾病后期由于结直肠癌的发展，它可能成为危及生命的疾病。有趣的是，即使在散发性 CRC 患者中检测到的发病特征也可以在 UC 相关的结直肠癌（UC-CRC）中发现，但后者通常是由非肿瘤性炎症上皮到异型增生再到癌症的炎症驱动途径引起的。因此，建议进行长期随访结肠镜监测。大约 15%的 UC 患者会出现严重结肠炎的急性发作，其中 30%的患者需要结肠切除术。UC 的初始治疗策略通常遵循传统的逐步升级方法。三分之一的患者对类固醇治疗没有反应，在这些情况下，环孢素和英夫利昔单抗是最常用的挽救药物，以避免紧急手术。不幸的是，尽管英夫利昔单抗治疗后观察到了显著的短期获益，但结肠切除术的比率仍然保持稳定。UC 的手术取决于疾病的阶段以及患者的状况，并分为以下几种情况：紧急、紧急和选择性。尽管做了很多努力，但 UC 的手术管理仍然是一个重大挑战。对 UC 进行多学科管理是关键，以便根据每个患者的具体情况确定最佳时机和最佳手术程序。
