溃疡性结肠炎术后早期并发症的预防及处理

Prophylaxis and treatment of postoperative early complication in ulcerative colitis

目的总结分析溃疡性结肠炎外科治疗术后并发症的发生原因及处理经验。方法回顾性分析1995年1月至2005年12月手术治疗26例溃疡性结肠炎的临床资料。因结肠出血、肠穿孔、中毒性巨结肠和吻合口瘘等并发症入院病人19例,内科治疗无效而无并发症入院病人7例。其中急诊手术12例,择期手术14例;全结肠直肠切除术11例,结肠部分切除和结肠单纯造口术15例。结果11例(18例次)病人术后出现并发症,并发症发生率为42.3%,急诊手术后并发症发生率较高,主要为切口并发症和吻合口瘘。4例吻合口瘘病人2例保守治疗痊愈,2例再次手术,共有2例病人死亡。结论全结肠直肠切除术是治疗溃疡性结肠炎的有效手段,合理掌握手术时机和采取合理的手术方式能够降低术后并发症的发生率。对于常见的吻合口瘘并发症,通过持续骶前灌洗、通畅引流以及有效的贮袋引流减压等保守治疗,可使吻合口瘘闭合。

Objective To summarize and analyze the cause and management experience of postoperative early complication in ulcerative colitis. Methods The clinical data of 26 cases of ulcerative colitis underwent surgery operation between January 1995 and December 2005 was analyzed retrospectively. In the all, 19 cases were admitted because of the complications, such as colonic hemorrhage, colon perforation, toxic megacolon, stoma fistula and so on. And 7 cases were because of the failure of medical treatment. Twelve cases underwent emergency operation, and 14 patients were selective operation. Total coloproctectomy were performed in 11 cases, and partial colectomy and colostomy were performed in 15 patients. Resuits Postoperative complication occurred in 11 patients, and the total incidence rate was 42.3%. The incidence rate was high in cases performed emergency operation. The major complications were abdominal incision-related complications and stoma fistula. In the 4 cases of occurred stoma fistula,2 patients recovered by expectant treatment, and 2 patients underwent reoperation. Among all cases,2 cases died. Conclusion Total coloproctectomy is effecive method to treatment ulcerative colitis, and the incidence rate of postoperative complication could be cut down by reasonable selection of operation juncture and method. Continual presacral irrigation, unobstructed draining and decompression of pouch are feasible and effective in treatment of stoma fistula.