Mikkola K A
Second Department of Surgery, Helsinki University Central Hospital, Finland.
Eur J Surg. 1997 Feb;163(2):129-34.
To find out if the change in the operation of choice for ulcerative colitis from proctocolectomy with conventional ileostomy to restorative proctocolectomy which occurred during the 1980s had any influence on the indications for operation.
Retrospective analysis.
University hospital, Finland.
430 consecutive patients who underwent operations for ulcerative colitis: 154 patients during 1976-85, when conventional proctocolectomy was the first choice, and 276 patients in 1986-94, when restorative proctocolectomy was the operation of choice.
Comparison of the main surgical indications between the two periods.
The indication for the first operation for three groups of patients: acute colitis, chronic colitis, and carcinoma (or at risk of cancer).
The annual number of patients operated on roughly doubled even though the duration of colitis became longer and the age of patients older. The percentage of patients with "acute colitis" decreased from 29% (45/154) to 20% (55/276) (p = 0.032) and that of "chronic colitis" increased from 52% (80/154) to 65% (179/276) (p = 0.01) during the study period, while patients operated on for risk of carcinoma decreased slightly (19%, 29/154, compared with 15%, (42/276) p = 0.35).
The adoption of restorative proctocolectomy has not caused any significant changes in indications for operation in ulcerative colitis. On the contrary, the medical control is better than before, but dealing with the risk of cancer remains difficult.
探究20世纪80年代溃疡性结肠炎的首选手术方式从传统回肠造口直肠结肠切除术转变为保留肛门的直肠结肠切除术是否对手术指征有任何影响。
回顾性分析。
芬兰大学医院。
430例连续性接受溃疡性结肠炎手术的患者：1976 - 1985年期间有154例患者，当时传统直肠结肠切除术是首选；1986 - 1994年期间有276例患者，此时保留肛门的直肠结肠切除术是首选手术方式。
比较两个时期的主要手术指征。
三组患者首次手术的指征：急性结肠炎、慢性结肠炎和癌（或有癌症风险）。
尽管结肠炎病程延长且患者年龄增大，但每年接受手术的患者数量大致翻倍。在研究期间，“急性结肠炎”患者的比例从29%（45/154）降至20%（55/276）（p = 0.032），“慢性结肠炎”患者的比例从52%（80/154）增至65%（179/276）（p = 0.01），而因癌症风险接受手术的患者略有减少（19%，29/154，相比15%，42/276，p = 0.35）。
采用保留肛门的直肠结肠切除术并未导致溃疡性结肠炎手术指征发生任何显著变化。相反，医疗控制比以前更好，但应对癌症风险仍然困难。
