Cavallaro V, Bonaccorso R, Catania V, Barbarino F, Faraci C, Lo Faro F, Minutolo V, Cammisuli F
Istituto di I Clinica Chirurgica Generale e Terapia Chirurgica, Università degli Studi, Catania.
Minerva Chir. 1997 Apr;52(4):337-45.
The authors report their experience of 23 patients with ulcerative colitis treated with surgery from 1991 to 1994. At admission 8 patients had a high-grade illness, 10 patients had a middle-grade illness, 5 patients had a toxic megacolon. All the patients were treated with systemic medical management (mesalazine + methylprednisolone) and topical medical management with rectal steroid (methylprednisolone) and rectal mesalazine by enema, and with nutritional support (Total Parenteral Nutrition). The 5 patients with toxic megacolon, after 48 hours of unsuccessful medical management, underwent surgery with deferred urgency; the other 18 patients underwent surgery after one-four months. The authors prefer the ileorectal anastomosis (IRA), since the rectal lesions are more susceptible to topical therapy. A single-stage IRA was performed in 17 patients. A sigmoid resection has been employed in the first stage in the 18th patient with a local development of the disease in the sigma; a following relapse of the lesions required a total colectomy with a low ileorectal anastomosis. A first-stage subtotal colectomy with ileostomy and Hartmann closure of the rectum with low ileorectal anastomosis at a later date was performed in the 5 patients with toxic megacolon. One of these, 18 years old, died after a heart failure. After surgery, as soon as the patients start moving their bowels all of these had again a systemic therapy with mesalazine for a short period and after they had a topical therapy with mesalazine + methylprednisolone by enema, for a long period. The average postoperative period of admission was 16.3 days. The functional results have been encouraging with an average of 1.6 bowel movements daily and an average of 0.4 nocturnal bowel movements. All the patients had a normal anal sphincter function with an acceptable stool frequency. In male patients there no urinary or sexual defects. In one case of these, there was a low grade of dysplasia, revealed by endoscopic biopsy. The authors conclude that today surgical treatment of ulcerative colitis is not well established.
作者报告了他们在1991年至1994年期间对23例溃疡性结肠炎患者进行手术治疗的经验。入院时，8例患者病情严重，10例患者病情中等，5例患者患有中毒性巨结肠。所有患者均接受了全身药物治疗（美沙拉嗪+甲泼尼龙）、局部药物治疗（直肠类固醇（甲泼尼龙）和直肠美沙拉嗪灌肠）以及营养支持（全胃肠外营养）。5例中毒性巨结肠患者在药物治疗48小时无效后，接受了延期紧急手术；其他18例患者在1至4个月后接受了手术。作者倾向于采用回肠直肠吻合术（IRA），因为直肠病变更易接受局部治疗。17例患者进行了一期IRA。第18例患者因乙状结肠局部病变，在第一阶段进行了乙状结肠切除术；随后病变复发，需要进行全结肠切除术并低位回肠直肠吻合术。5例中毒性巨结肠患者进行了一期次全结肠切除术加回肠造口术，后期行直肠Hartmann关闭术及低位回肠直肠吻合术。其中1例18岁患者死于心力衰竭。术后，患者一旦开始排便，均再次接受了短期的美沙拉嗪全身治疗，之后长期接受美沙拉嗪+甲泼尼龙灌肠的局部治疗。术后平均住院时间为16.3天。功能结果令人鼓舞，平均每天排便1.6次，夜间平均排便0.4次。所有患者肛门括约肌功能正常，排便频率可接受。男性患者无泌尿或性功能缺陷。其中一例经内镜活检显示有低度发育异常。作者得出结论，目前溃疡性结肠炎的外科治疗尚未完全确立
