Surgery in ulcerative colitis: When? How?
Surgery in ulcerative colitis: When? How?
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DOI：
10.1016/j.bpg.2018.05.017
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发表时间：
2018-02-01
影响因子：
3.2
通讯作者：
Spinelli, Antonino
中科院分区：
文献类型：
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作者：
Gallo, Gaetano;Kotze, Paulo Gustavo;Spinelli, Antonino
溃疡性结肠炎（UC）是一种特发性慢性缓解性炎症性肠病，其特征是结肠粘膜连续炎症影响直肠，通常以连续的方式向近端延伸至整个结肠。患者通常经历间歇性恶化，症状特征为血性腹泻伴急症和尿急。粘膜受累的解剖程度是决定疾病进程的最重要因素，也是结肠切除术的重要预测因素。UC的确切病因尚不清楚。然而，遗传易感性和环境因素的结合似乎在疾病的发展中起着关键作用。UC通常是轻度活动性的，但由于结肠和全身并发症，以及在疾病过程后期由于结直肠癌的发展，它可能是一种危及生命的疾病。有趣的是，即使在散发性结直肠癌患者中检测到的病理特征也可以在uc相关结直肠癌（UC-CRC）中发现，后者通常是由炎症驱动的途径驱动的，从非肿瘤性炎症上皮到不典型增生再到癌症。因此，建议进行结肠镜检查的长期随访。大约15%的UC患者发展为严重结肠炎的急性发作，其中30%的患者需要结肠切除术。UC的初始治疗策略通常遵循传统的逐步治疗方法。三分之一的患者对类固醇治疗无反应，环孢素和英夫利昔单抗是这些病例中最常用的抢救药物，以避免紧急手术。不幸的是，尽管英夫利昔单抗治疗后观察到显着的短期获益，但结肠切除术率保持稳定。UC的手术取决于疾病的阶段和患者的状态，分为以下三种情况：紧急、紧急和择期。尽管做出了许多努力，UC的外科治疗仍然是一个重大挑战。UC的多学科管理是关键，以便在个性化的基础上为每位患者确定最佳时机和最佳程序。(C) 2018 Elsevier Ltd.版权所有。
Ulcerative Colitis (UC) is an idiopathic chronically-remitting inflammatory bowel disorder characterized by a contiguous inflammation of the colonic mucosa affecting the rectum that generally extends proximally in a continuous manner through the entire colon. Patients typically experience intermittent exacerbations, with symptoms characterized by bloody diarrhea associated with urgency and tenesmus. The anatomical extent of mucosal involvement is the most important factor determining disease course and is an important predictor of colectomy.The precise etiology of UC is unknown. However, a combination of genetic predisposition and environmental factors seems to have a key role in the development of the disease. UC usually is mildly active but it can be a life-threatening condition because of colonic and systemic complications, and later in the disease course due to the development of colorectal cancer. Interestingly, even if pathogenetic features detected in patients with sporadic CRC can be also found in UC-related colorectal cancer (UC-CRC), this latter is, usually, driven by an inflammation-driven pathway rising from a non-neoplastic inflammatory epithelium to dysplasia to cancer. Thus, a long-term follow-up with colonoscopy surveillance has been recommended.Approximately 15% of UC patients develop an acute attack of severe colitis, and 30% of these patients require colectomy. The initial treatment strategy in UC typically follows the traditional step-up approach. One third of the patients will not respond to steroid therapy and cyclosporine and infliximab are the most common salvage agents employed in these cases in order to avoid emergent surgery. Unfortunately, although a significant short-term benefit have been observed after infliximab treatment, the colectomy rate have remained stable. Surgery in UC depends on the stage of the disease as well as patient's status and is divided into the following settings: urgent, emergent and elective. Despite many efforts the surgical management of UC remains a significant challenge. A multidisciplinary management of UC is key in order to define the best timing and the best procedure for each patient in an individualized basis. (C) 2018 Elsevier Ltd. All rights reserved.