Surgical Treatment of Ulcerative Colitis

潰瘍性大腸炎的外科治療

黃思銘(Ssu-Ming Huang) ； 許自齊(Tzu-Chi Hsu)

《Formosan Journal of Surgery》 40卷2期 (2007/04) Pp. 67-74

https://doi.org/10.29833/FJS.200704.0002

摘要

西方醫學文獻對於潰瘍性大腸炎手術治療已有充分的探討，然而臺灣在這方面的文獻很稀少。
此研究的目的是要評估連續三十五位病人由同一手術者執行不同種類手術之術後結果。
分析從民國七十二年十二月到民國九十四年八月這段期間，所有接受手術治療的三十五位病人。焦點放在手術適應症以及術後功能，同時將本研究結果與過去文獻比較。
一位病人實施全大腸直腸切除術同時接受迴腸造瘻，有良好的初期術後功能。一位病人實施全大腸切除併迴腸造瘻後死於敗血症及既有的心臟疾病。十一位病人接受全大腸切除併迴腸直腸吻合術，皆有良好術後功能。二十二位病人接受回復式大腸直腸切除手術，無一人因手術而死亡。併發症之發生率與文獻所報告者相似。有五位病人(22.72%)最終還是須切除迴腸囊袋。日間與夜間平均排便次數分別是4.2與2.2次。三位病人有間歇性的迴腸囊袋發炎，皆可由內科治療得到控制。
有數種不同的手術方法可以用來治療潰瘍性大腸炎病患。每種方法都有其優缺點，所以應該與病人在術前有充分的討論。回復式大腸直腸切除手術後的結果在此研究看來是可接受的，但應由有經驗的醫師來執行。

並列摘要

Objective: The outcomes of surgical management for ulcerative colitis (UC) in western people have been well discussed in the literature. However, there are few reports of surgical treatment of UC in Taiwan. The aim of this study was to evaluate outcomes of 35 consecutive patients who underwent different colectomies by a single surgeon.
Methods: A series of 35 patients who received surgical treatment for UC between December 1983 and August 2005 were analyzed. The discussion is focused on the surgical indications and functional results after surgical treatment. Various articles in the literature are reviewed and their results compared with ours.
Results: Total proctocolectomy with conventional Brooke ileostomy was performed in one patient with an initially favorable outcome. Total colectomy with ileostomy was performed in one patient, who, however, succumbed to heart disease and sepsis postoperatively. Eleven patients underwent total colectomy with ileorectal anastomosis and all had satisfactory functional outcomes. Twenty-two patients received restorative proctocolectomy. There was no operation-related death. The morbidity rate was as high as that in the literature. Five pouches (23%) have been excised for pouch failure. The mean daytime and nighttime frequencies were 4.2 and 2.2 times respectively. Three patients (15%) with intermittent pouchitis were ameliorated by medical treatment.
Conclusions: Several surgical options are available for the treatment of ulcerative colitis. Each option has its place and should be discussed with every patient. The outcome of restorative proctocolectomy for UC in this series performed by one experienced surgeon was acceptable.

並列關鍵字

ulcerative colitis UC ； ileal pouch anal anastomosis ； restorative proctocolectomy