溃疡性结肠炎的外科治疗16例分析

Surgical treatment of ulcerative colitis, report of 16 cases

目的探讨溃疡性结肠炎的外科治疗方式。方法对16例行外科手术治疗的溃疡性结肠炎的临床资料进行回顾性分析。结果本组16例行外科手术治疗,占全部收治患者的 20．5％(16／78)。手术原因包括保守治疗无效10例,肠梗阻3例,合并息肉可疑癌变3例。行全结直肠切除、回肠造口术8例,全结直肠全切除、回肠肛管吻合术4例,结肠全切除、回直肠吻合术2例,结肠部分切除2例。结论溃疡性结肠炎主要手术指征为内科治疗无效或合并肠梗阻及并发息肉可疑癌变者。全结肠切除、回肠造口术治疗较彻底,全结直肠切除、回肠贮袋肛管吻合术可改善排便控制功能,但吻合口溃疡发生率高。

Objective To explore surgical treatment of ulcerative colitis （UC）. Methods Clinical data of 16 patients of UC undergoing surgery were retrospectively analyzed. Results In this series, 16 out of 78 UC patients undergoing surgery included failing to control symptom by conservative therapy in 10, bowel obstruction in 3 , suspected malignance in 3. Eight cases underwent total proctocolectomy and ileostomy, 4 with total proctocolectomy and ileal pouch-anal anastomosis （ IPAA）, 2 with total colectomy and ileorectal anastomosis, 2 with partial colectomy. Conclusions The main indications for surgery in UC patients were failure of medical treatment, complicated bowel obstruction and suspected malignance. Total proctocolectomy and ileostomy is a cure for UC, total proctocolectomy and ileal pouch-anal anastomosis benifits defecation control but suffering from high incidence of stomal ulcer.