UC手术治疗PPT课件

腹腔镜微创技术助力UC手术治疗 金华市中心医院 结直肠肛门外科 . Ulcerative colitis,UC 1 发病率增加 2 手术比率增加 15%-30% 3 手术的重视度 不够 内科治疗 外科治疗 UC MDT surgery FIGURE 1. Cumulative risk of surgery related to IBD among patients with UC stratified by age at diagnosis as young adults (18 40 yr),middle-age adults (4164 yr), and elderly ($65 yr). FIGURE 2. Cumulative risk of surgery related to IBD among patientswith CD stratified by age at diagnosis as young adults (1840 yr),middle-age adults (4164 yr), and elderly ($65 yr). 1 Nguyen G C, Bernstein C N, Benchimol E I. Risk of Surgery and Mortality in Elderly-onset Inflammatory Bowel Disease: A Population-based Cohort StudyJ. Inflamm Bowel Dis. 2017, 23(2): 218-223. Restorative proctolectomy IPAA VS IRA (ilealpouch-anal anastomosis) (total colectomy with ileorectal anastomosis ) MTV(maximum tolerated volume) 120ML;RC(rectal compliance) 1.5 ml air/mmhg 1 Tonelli F, Di Martino C, Giudici F. Could Total Colectomy with Ileorectal Anastomosis Be an Alternative to Total Proctocolectomy with Ileal Pouch-Anal Anastomosis in Selected Ulcerative Colitis Patients?J. Gastroenterol Res Pract. 2016, 2016: 5832743. laparoscopic VS open 1 Magro F, Gionchetti P, Eliakim R, et al. Third European Evidence-Based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disordersJ. J Crohns Colitis. 2017. 腹腔镜微创IPAA手术就其操作设备而言包括 传统腹腔镜、机器人腔镜方式1；就其辅助 切口而言包括多孔、单孔及自然腔道2-5。 微创手术较传统开放手术具有显著的微创 优势6, 7，有助于提升患者的手术耐受8， 一定程度上可能会对UC手术的适应症产生 影响。 1 Mark-Christensen A, Pachler F R, Norager C B, et al. Short-term Outcome of Robot-assisted and Open IPAA: An Observational Single-center StudyJ. Dis Colon Rectum. 2016, 59(3): 201-207. 2 Rencuzogullari A, Stocchi L, Costedio M, et al. Characteristics of learning curve in minimally invasive ileal pouch-anal anastomosis in a single institutionJ. Surg Endosc. 2017, 31(3): 1083-1092. 3 Leo C A, Samaranayake S, Perry-Woodford Z L, et al. Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single-incision abdominal laparoscopic surgeryJ. Colorectal Dis. 2016, 18(12): 1162-1166. 4 Baek S J, Dozois E J, Mathis K L, et al. Safety, feasibility, and short-term outcomes in 588 patients undergoing minimally invasive ileal pouch-anal anastomosis: a single-institution experienceJ. Tech Coloproctol. 2016, 20(6): 369-374. 5 de Buck V O A, Wolthuis A M, DHoore A. Transanal completion proctectomy after total colectomy and ileal pouch-anal anastomosis for ulcerative colitis: a modified single stapled techniqueJ. Colorectal Dis. 2016, 18(4): O141-O144. 6 Jani K, Shah A. Laparoscopic total proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitisJ. J Minim Access Surg. 2015, 11(3): 177-183. 7 Colombo F, Sahami S, de Buck V O A, et al. Restorative Proctocolectomy in Elderly IBD Patients: A Multicentre Comparative Study on Safety and EfficacyJ. J Crohns Colitis. 2016. 8 Okita Y, Araki T, Hiro J, et al. Systemic Acute-phase Response in Laparoscopic and Open Ileal Pouch Anal Anastomosis in Patients With Ulcerative Colitis: