CAJ | 학술논문

目的：探讨溃疡性结肠炎（UC）手术治疗的指征、时机、方式及转归。方法回顾性分析32例接受手术治疗的 UC 患者的住院病历资料，记录患者的临床表现、诊疗过程、手术方式及转归，并对患者术后情况进行随访。结果71.9%（23/32）手术病例为重型 UC；初发型占21.9%（7/32），慢性复发型78.1%（25/32）；广泛结肠病变占93.8%（30/32），其中全结肠受累占81.3%（26/32）。手术原因：药物治疗不能达到或维持缓解26例（81.3%）；UC 相关结直肠癌（UC-CRC）/上皮内瘤变（IEN）5例（15.6%）；并发肠穿孔1例（3.1%）。手术方式：全结直肠切除、回肠储袋肛管吻合术（IPAA）19例（59.4%），回肠永久造瘘术或长期保留造瘘口7例（21.9%），全结肠或次全结肠切除、肠吻合术6例（18.8%）。术后并发症发生率69.6%（16/23），分别为肠梗阻9例、吻合口狭窄2例、盆腔感染2例、直肠阴道瘘1例、切口疝1例、储袋炎2例、残余直肠 UC 复发2例。25例（78.1%）患者接受随访2个月~22年，21例 UC 治愈，2例因残余直肠 UC 复发继续药物治疗，2例因 UC-CRC 广泛转移死亡。结论手术是药物难治性及出现并发症 UC 的治疗选择，多数患者手术效果满意，术后并发症发生率较高，手术时机、术式及术后并发症的预防及随访有待进一步规范。
목적：탐토궤양성결장염（UC）수술치료적지정、시궤、방식급전귀。방법회고성분석32례접수수술치료적 UC 환자적주원병력자료，기록환자적림상표현、진료과정、수술방식급전귀，병대환자술후정황진행수방。결과71.9%（23/32）수술병례위중형 UC；초발형점21.9%（7/32），만성복발형78.1%（25/32）；엄범결장병변점93.8%（30/32），기중전결장수루점81.3%（26/32）。수술원인：약물치료불능체도혹유지완해26례（81.3%）；UC 상관결직장암（UC-CRC）/상피내류변（IEN）5례（15.6%）；병발장천공1례（3.1%）。수술방식：전결직장절제、회장저대항관문합술（IPAA）19례（59.4%），회장영구조루술혹장기보류조루구7례（21.9%），전결장혹차전결장절제、장문합술6례（18.8%）。술후병발증발생솔69.6%（16/23），분별위장경조9례、문합구협착2례、분강감염2례、직장음도루1례、절구산1례、저대염2례、잔여직장 UC 복발2례。25례（78.1%）환자접수수방2개월~22년，21례 UC 치유，2례인잔여직장 UC 복발계속약물치료，2례인 UC-CRC 엄범전이사망。결론수술시약물난치성급출현병발증 UC 적치료선택，다수환자수술효과만의，술후병발증발생솔교고，수술시궤、술식급술후병발증적예방급수방유대진일보규범。
Objective To analyze the indication,timing,procedures and outcomes of surgical treatment of ulcerative colitis(UC). Methods A total of 32 UC cases with surgical treatment were studied retrospectively. Medical records were reviewed for clinical manifestations,process of diagnostic and surgical procedures and outcomes. Postoperative situation was followed up after surgery. Results Severe UC ac-counted for 71. 9%(23 / 32)of all surgical cases. Initial onset type accounted for 21. 9%(7 / 32)and chron-ic relapse type accounted for 78. 1%(25 / 32). Extensive colitis accounted for 93. 8%(30 / 32)and 81. 3%(26 / 32)were pan colitis. Operation causes included 26(81. 3% )cases of failures of medicine treatment or maintained remission,5 cases(15. 6% )of UC-associated colorectal cancer(UC-CRC)or intraepithelial ne-oplasia(IEN)and 1 case with complication of perforation. Surgical procedures included 19 cases(59. 4% ) with proctocolectomy and ileal pouch-anal anastomosis(IPAA),6 cases(18. 8% )with colectomy or subco-lectomy and anastomosis with or without proctomy and 7 cases(21. 9% )with permanent ileostomy or long-term maintenance of the stoma. A total of 25 patients(78. 1% )were followed up for 2 months to 22 years, including 21 cured cases,2 cases with continued drug therapy for relapsing at the remnant rectum and 2 cases of death caused by CRC metastasis. A total of 69. 6%(16 / 23)cases experienced postoperative com-plications,including 9 cases of intestinal obstruction,2 cases of anastigmatic stenosis,2 cases of pelvic in-fection,1 case of rectovaginal fistula,1 case of incision hernia,2 cases of pouchitis and 2 cases of relapsed UC at the remnant rectum. Conclusion Surgical treatment is an effective option for refractory,severe or complicated UC. The operation outcomes is satisfactory though the complication rate is relatively high. The timing,surgical pocedures postoperative complication prevention and follow-up need further standardiza-tion.