全结肠切除加回肠贮袋-肛管吻合术治疗溃疡性结肠炎

Treatment of ulcerative colitis by total colectomy ileal pouch-anal anastomosis

溃疡性结肠炎（UC）是一种发生在结直肠黏膜及黏膜下组织的慢性弥漫性炎性病变．根据病变的严重程度和范围不同．需采取不同的治疗方法。大多数患者经内科治疗．可得到缓解．但有约25％的患者对内科治疗无效或出现并发症．需行手术治疗。全结肠切除、直肠黏膜剥脱加回肠贮袋-肛管吻合术（IPAA）目前已经成为UC患者行手术治疗的标准术式。继续改进贮袋的设计可能会进一步降低术后并发症发生率，减少每日排粪频率和排粪失禁次数。在腹腔镜下行IPAA手术可以减少手术创伤．减轻腹腔粘连和小肠梗阻的发生．合理掌握手术时机．采取合适的手术方式．术中对常见的并发症采取预防措施是手术成功治愈UC的关键。

Ulcerative colitis （UC） is a relapsing and remitting disease characterised by chronic mucosal and submucosal inflammation of the colon and rectum. Treatment may vary depending upon the extent and severity of inflammation. Broadly speaking medical treatments can induce and maintain remission. Approximately 25% of patients with UC ultimately require colectomy for ineffective medical treatment or complications. Ileal pouch-anal anastomosis （IPAA） has become the standard of care for patients with ulcerative colitis who ultimately require colectomy. Improvement in pouch technique may decrease the perioperative complication rate and postoperative stool frequency. Laparoscopic IPAA can lessen surgical trauma, abdominal adhesion and intestinal obstruction. Timing of surgery, appropriate surgical technique, and prevention ofpostoperative complications are the keys to successful treatment of UC.