Binderow S R, Wexner S D
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309.
Dis Colon Rectum. 1994 Jun;37(6):610-24. doi: 10.1007/BF02051000.
There are numerous surgical options for the treatment of mucosal ulcerative colitis.
This article reviews the currently available options for the treatment of mucosal ulcerative colitis. Separate discussions will explore both the options in the emergency and elective settings.
Patients with mucosal ulcerative colitis may undergo surgery either as an emergency or in the elective setting. Emergency surgery is usually performed for one of the life-threatening complications of ulcerative colitis: fulminant colitis, toxic megacolon, or massive hemorrhage. The most commonly performed procedure under these conditions is a subtotal colectomy with end ileostomy. The rectal stump may be handled in a variety of ways. This procedure avoids proctectomy or anastomosis. Thus, patients will still have all necessary anatomic structures to allow for any of the definitive elective procedures. Elective surgery is performed for intractable disease, complications of medical therapy, dysplasia, or, occasionally, extraintestinal manifestations. In the elective setting, a definitive operation can be done to remove most or all of the disease-bearing colorectum and leave the patient with a means to control fecal elimination. Total abdominal colectomy with ileorectal anastomosis leaves the patient with diseased bowel but obviates the need for pelvic dissection. Although total proctocolectomy removes all potentially diseased mucosa, these patients have a permanent ileostomy. The stoma can either be a standard Brooke's ileostomy or a continent Kock pouch. The most common definitive procedure currently performed is the near-total proctocolectomy with ileal pouch-anal anastomosis. This option can be completed either with a rectal mucosectomy and hand-sewn anastomosis or with a double-stapled anastomosis, preserving the anal transition zone. This procedure is successful in eradicating almost all diseased mucosa while allowing the patient per anal defecation. Bowel movement frequency, degree of anal continence, and return to social and professional commitments have met with a great deal of satisfaction in most patients. A newer alternative to this procedure employs laparoscopy to facilitate a smaller incision. A one-stage procedure which omits the protective ileostomy and thus saves the patient one operation has also been used with some success in selected cases.
There are several surgical options for the treatment of mucosal ulcerative colitis. Each one has a role and should be discussed with the patient.
治疗黏膜性溃疡性结肠炎有多种手术选择。
本文回顾了目前治疗黏膜性溃疡性结肠炎的可用选择。将分别探讨急诊和择期情况下的选择。
黏膜性溃疡性结肠炎患者可在急诊或择期情况下接受手术。急诊手术通常针对溃疡性结肠炎的一种危及生命的并发症进行：暴发性结肠炎、中毒性巨结肠或大量出血。在这些情况下最常进行的手术是次全结肠切除术加末端回肠造口术。直肠残端可以有多种处理方式。该手术避免了直肠切除术或吻合术。因此，患者仍将保留所有必要的解剖结构，以便进行任何确定性的择期手术。择期手术针对难治性疾病、药物治疗的并发症、发育异常或偶尔的肠外表现进行。在择期情况下，可以进行确定性手术以切除大部分或全部患病的结直肠，使患者有控制排便的方法。全腹结肠切除术加回肠直肠吻合术使患者保留患病肠段，但无需进行盆腔清扫。虽然全直肠结肠切除术切除了所有潜在患病的黏膜，但这些患者有永久性回肠造口。造口可以是标准的布鲁克回肠造口或可控的考克贮袋。目前最常进行的确定性手术是近全直肠结肠切除术加回肠贮袋肛管吻合术。该选择可以通过直肠黏膜切除术和手工缝合吻合术或双吻合器吻合术完成，保留肛门移行区。该手术成功地根除了几乎所有患病黏膜，同时允许患者经肛门排便。大多数患者对排便频率、肛门节制程度以及恢复社交和职业活动都非常满意。该手术的一种较新替代方法采用腹腔镜以减小切口。一种省略保护性回肠造口从而为患者节省一次手术的一期手术在某些选定病例中也取得了一定成功。
治疗黏膜性溃疡性结肠炎有几种手术选择。每种选择都有其作用，应与患者进行讨论。
