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首页> 外文期刊>Current treatment options in gastroenterology >Surgical Indications and Procedures in Ulcerative Colitis.
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Surgical Indications and Procedures in Ulcerative Colitis.

机译：溃疡性结肠炎的外科手术适应症和程序。

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Chronic ulcerative colitis (CUC) is an inflammatory bowel disease limited to the mucosa of the rectum and colon. The inflammation begins in the rectum and progresses uninterrupted for variable distances. To date, no etiologic factor has been identified. However, population studies suggest there is both a genetic and environmental component contributing to the development of CUC. The natural history is one of a chronic inflammatory state, characterized by intermittent flares of disease activity. In a small number of patients, the initial presentation of CUC is of a fulminant nature. Medical therapy for the intestinal manifestations of CUC is directed at controlling symptoms through treatment of the underlying inflammatory process. Medical therapy is not curative for either the intestinal or extraintestinal manifestation of CUC. However, surgical removal of the colon and rectum cures the intestinal manifestations of the disease and eliminates or markedly reduces the associated risk of malignancy in longstanding CUC. The indications for surgical intervention are divided into two broad categories that influence the type of surgery performed: emergent and elective surgery. Emergency operations are directed at life-threatening complications of CUC and are not intended as definitive surgical treatment for CUC. Alternatively, elective surgery is intended as definitive treatment for the intestinal component of the disease. In appropriately selected patients, the best surgical treatment option is the total proctocolectomy with an ileal pouch-anal anastomosis (IPAA). The IPAA avoids the need for a permanent stoma and maintains the normal route of defecation. This is a technically demanding operation and should be performed by surgeons comfortable with the procedure. The severity and frequency of complications related to IPAA have decreased significantly since the introduction of the operations in the early 1980s. More importantly, long-term follow-up of IPAA patients has demonstrated that the functional results are durable and patient satisfaction remains high.
机译：慢性溃疡性结肠炎（CUC）是一种炎症性肠病，仅限于直肠和结肠的粘膜。炎症开始于直肠，并在不可变距离内不间断地发展。迄今为止，尚未发现病因。但是，人口研究表明，遗传和环境因素都对CUC的发展做出了贡献。自然病史是一种慢性炎症状态，其特征是疾病活动间歇性发作。在少数患者中，CUC的最初表现是暴发性的。 CUC肠道表现的药物治疗旨在通过治疗潜在的炎症过程来控制症状。对于CUC的肠道或肠外表现，药物治疗均不能治愈。但是，结肠和直肠的手术切除可治愈该疾病的肠道表现，并消除或显着降低长期CUC的相关恶性风险。手术干预的适应症分为影响手术类型的两大类：急诊手术和选择性手术。紧急手术针对的是危及生命的CUC并发症，并不打算作为CUC的权威性手术治疗。可选地，选择性外科手术旨在作为对该疾病的肠成分的确定性治疗。在适当选择的患者中，最佳的手术治疗选择是进行回肠囊直肠吻合术（IPAA）的全结肠直肠癌切除术。 IPAA避免了永久性造口的需要，并保持了正常的排便途径。这是一项技术要求很高的手术，应由熟悉手术程序的外科医生进行。自1980年代初期开始采用IPAA手术以来，与IPAA相关的并发症的严重程度和频率已大大降低。更重要的是，对IPAA患者的长期随访表明，其功能性结果持久且患者满意度很高。

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