溃疡性结肠炎19例手术原因分析

Surgical treatment of ulcerative colitis: an analysis of 19 cases

目的探讨经手术治疗的溃疡性结肠炎患者(UC)的临床资料及手术原因。方法收集2012年1月至2016年10月中国医科大学附属盛京医院收治的经手术治疗的19例UC患者的临床资料,对患者的临床表现、临床分型、病变范围、疾病程度、手术原因、手术方式等进行回顾性分析。结果同期我院共收治UC患者681例,手术患者所占百分比为2.79%。手术患者疾病严重程度包括轻度4例(21.05%),中度8例(42.11%),重度7例(36.84%)。手术原因包括合并癌变6例(31.58%),肠腔狭窄或肠梗阻反复发作5例(26.31%),肠腔布满息肉样隆起2例(10.53%),内科药物治疗无效6例(31.58%)。手术方式包括直肠癌根治术2例(10.53%),次全结肠切除术8例(42.10%),全结肠切除-回肠储袋-直肠吻合术3例(15.79%),全结直肠切除-回肠储袋-肛管吻合(IPAA)术1例(5.26%),全结直肠切除-回肠造口术5例(26.32%)。结论对具有手术指征的UC患者,应科学合理地选择手术方式,改善患者病情,提高患者的生活质量。

Objective To investigate the clinical data and surgical causes of 19 patients with ulcerative colitis（ UC）.Methods The clinical data of 19 UC patients receiving surgical treatment from January 2012 to October 2016 was collected,and the clinical manifestation,clinical classification,pathological range,degree of disease,operative causes and mode of operation were retrospectively analyzed. Results 681 patients with UC were admitted to our hospital in the same period,the percentage of patients with operation was about 2. 79%. In the severity of disease,there were 4 mild cases（ 21. 05%）,8 moderate cases（ 42. 11%） and 7 severe cases（ 36. 84%）. For the surgery causes,there were 6 cases（ 31. 58%） combined with carcinogenesis,5 cases（ 26. 31%） with intestinal stenosis or recurrent intestinal obstruction,2 cases（ 10. 53%） with intestinal polypoid protrusion,and 6 cases（ 31. 58%） with ineffective medical treatment. The surgical procedures included 2 radical resection of rectal cancer（ 10. 53%）,8 subtotal colectomy（ 42. 10%）,3 total colectomy ileal pouch-anal anastomosis（ 15. 79%）,1 total proctocolectomy with ileal pouch-anal anastomosis（ IPAA）（ 5. 26%） and 5 total proctocolectomy-back colostomy（ 26. 32%）. Conclusion For UC patients with surgical indications,the operation mode should be chosen scientifically and rationally to improve the condition and the life quality of patients.