371例不同时期手术治疗的溃疡性结肠炎患者的临床特点分析

Analysis of clinical characteristics of 371 patients with ulcerative colitis undergoing surgery during different periods

目的 探讨近30年不同时期行手术治疗的溃疡性结肠炎(UC)患者临床特点.方法 回顾性分析1987年至2017年手术治疗371例UC患者性别、年龄、病程、病变范围、疾病严重程度、术前治疗药物、手术时机和方式及术后并发症,比较各时期患者的临床特点.结果 近30年来,手术治疗的UC患者逐渐增加.与1987～ 1996年组相比,1997～ 2006年组和2007～2017年组的急诊手术患者比例减少(10.4％比2.1％,P=0.026;10.4％比0.5％,P=0.002),行全结肠直肠切除回肠储袋肛管吻合术患者比例增加(77.1％比92.9％,P=0.003;77.1％比96.7％,P＜ 0.001),术后并发症发生率降低(97.9％比39.0％,P＜0.001;97.9％比22.0％,P＜0.001).结论 近30年UC的外科手术治疗理念不断提升,围手术期管理理念改进,预防性回肠双腔造口患者比例提高,术后并发症发生率下降.

Objective To investigate the clinical characteristics of patients with moderate to severe ulcerative colitis (UC) undergoing surgery during different decades in recent 30 years.Methods The gender,age,duration of disease,extent of disease,severity of disease,preoperative medication treatment,timing and mode of operation,and postoperative complications of 371 UC patients undergoing operation from 1987 to 2017 were analyzed retrospectively.Their clinical characteristics of different decades were compared.Results In the past 30 years,UC patients receiving operation increased gradually.Compared with the 1987-1996 group,the ratio of emergency surgery patients in the 1997-2006 group and the 2007-2017 group significantly decreased (10.4％ vs.2.1％,P=0.026;10.4％ vs.0.5％,P=0.002);the ratio of patients undergoing total proctocolectomy with ileal pouch-anal anastomosis significantly increased (77.1％ vs.92.9％,P =0.003;77.1％ vs.96.7％,P＜0.001),and the morbidity of postoperative complication significantly decreased (97.9％ vs.39.0％,P＜ 0.001;97.9％ vs.22.0％,P＜ 0.001).Condusion In the past 30 years,the concept of surgical treatment and perioperative management of UC has been continuously improved;the proportion of patients with preventive ileal double-chamber stoma has increased;the morbidity of postoperative complications has decreased.