急性重症溃疡性结肠炎的诊治

Management of Acute Severe Ulcerative Colitis

急性重症溃疡性结肠炎(ASUC)为内科急症,需要迅速判断和及时处理。静脉使用激素为其一线治疗方案,但超过30%的患者对激素抵抗。激素治疗3d,需及时判断疗效,对激素抵抗者需选择转换治疗方案。环孢素和英夫利西单抗作为拯救治疗显示出较好的疗效和安全性。如药物拯救治疗4~7d仍无效,则需考虑手术治疗。全结直肠切除术加回肠储袋肛管吻合术是标准术式,推荐三期手术方案,并注意术后并发症。ASUC的诊治需要内、外科等多学科协作,以改善疾病预后,降低死亡率。

Acute severe ulcerative colitis (ASUC) is a medical emergency that requires prompt diagnosis and treatment. Intravenous corticosteroids are the first-line medical therapy, yet over 30% of the patients are steroid-refractory. The response to steroids should be assessed on day 3 after treatment initiation;in non-responders, treatment options including ciclosporin and infliximab, or surgery should be considered. Both ciclosporin and infliximab are effective and safe salvage therapy. Colectomy is recommended if there is no improvement following 4 to 7 days of salvage therapy. Total proctocolectomy and ileal pouch-anal anastomosis is the standard surgical procedure. A three-step approach is advocated and the postoperative complications should be cared. The diagnosis and treatment of ASUC requires multidisciplinary cooperation in order to improve prognosis and reduce mortality.