炎症性肠病的外科治疗进展

Advances in the surgical management of inflammatory bowel disease

炎症性肠病(IBD)是肠道慢性、迁延性的炎症性疾病.随着病程延长,>70%的克罗恩病和接近1/3的溃疡性结肠炎(UC)患者最终需要接受手术治疗.IBD的疾病分型、严重程度、术前用药、手术史、术者经验、手术技术等个体化因素影响短期并发症的发生和患者的长期预后.克罗恩病的外科治疗目标在于减少手术并发症,避免或延缓术后复发,改善生命质量.近年来,术前优化治疗、限制性肠管切除、早期手术、肠系膜扩大切除、Kono-S吻合等为代表的克罗恩病手术理念和技术不断完善和发展.全结直肠切除加回肠储袋肛管吻合术是UC外科治疗的首选方式,其手术分期演进和技术细节优化可以提高UC手术疗效.随着IBD治疗理念和方式的革新,规范的外科治疗体系正逐渐形成,必将进一步改善IBD的治疗疗效.笔者查阅相关文献,结合团队实践经验,深入阐述IBD的外科治疗进展,以期推动IBD外科的规范化治疗.

Inflammatory bowel disease(IBD)is a chronic,progressive inflammatory disease of the gastrointestinal tract.With prolonged disease duration,more than 70%of patients with Crohn's disease(CD)and nearly one-third of patients with ulcerative colitis(UC)eventually require surgical intervention.Individualized factors,such as disease phenotype,severity,preoperative medications,surgical history,surgeon's experience,and surgical technique adopted affect the short-term post-operative complications and long-term prognosis of IBD.The goals of surgical treatment of CD are to reduce complications,avoid or delay postoperative recurrence,and improve quality of life.In recent years,the surgical concepts and techniques of CD represented by preoperative optimization,restric-tive bowel resection,early surgery,extensive mesenteric resection,and Kono-S anastomosis have been improved and developed.Total proctocolectomy plus ileal pouch-anal anastomosis(IPAA)is the preferred surgical procedure of UC,and the evolution of IPAA staging and optimization of tech-nical details have further improved the efficacy.With the innovation of IBD treatment concepts and modalities,a standardized surgical treatment system is gradually being formed,which will further improve the efficacy of IBD treatment.Based on the relevant literature and practical experience,the authors review the latest progress of surgical treatment of IBD,aiming to promote the standardized treatment of IBD surgery.