炎症性肠病外科治疗最新进展——手术方式和技术

Recent advances in surgical management of inflammatory bowel disease——surgical methods and techniques

炎症性肠病(inflammatory bowel disease,IBD)因其严重的并发症往往离不开外科手术治疗,而患者的个体化差异决定了手术方式和技术的差异性,在IBD术者不断的探索和总结下,IBD的外科治疗逐渐规范化。在克罗恩病的外科治疗中,如何有效减少和避免术后复发是一项难题。近年来以肠管切除范围、吻合方式等为代表的手术方式和技术对疾病进展的影响取得了一定的进展。全结肠切除后的回肠储袋肛管吻合术(ileal pouch-anal anastomosis,IPAA)成为溃疡性结肠炎(ulcerative colitis,UC)外科首选治疗方式;IPAA手术的部分分期方式,如二期手术和改良二期手术对UC患者的近期和远期治疗效果亦取得了一定的成功。IBD手术治疗逐渐走向规范化,预示着IBD的认知和处理手段逐渐形成体系,相信未来会有更多的手术方式和技术的革新能够有效减少复发,避免并发症的发生。

Inflammatory bowel disease(IBD)often requires surgical treatment because of its severe complications.However,the individual differences of patients determine the difference of surgical methods and techniques.With the continuous exploration and summary of IBD surgeons,the surgical treatment of IBD has gradually stepped into standardization.In the surgical treatment of Crohn’s disease,how to effectively reduce and avoid postoperative recurrence is a difficult problem.The influence of surgical methods and techniques on disease progression represented by the range of intestinal resection and anastomosis has made some progress in recent years.For the surgical treatment of ulcerative colitis(UC),ileal pouch-anal anastomosis(IPAA)after total colectomy became the first choice,and some of the staging methods of IPAA surgery,such as secondary surgery and modified secondary surgery,have also made some successful studies on the short-term and long-term therapeutic effects of UC patients.The gradual normalization of surgical treatment indicates that the cognitive and management methods of IBD have gradually formed a system.It is believed that there will be more surgical methods and technical innovations in the future to effectively reduce recurrence and avoid complications.