外科学结直肠与肛管疾病.ppt

思考题 结肠癌病理分型有哪些？ 改良Dukes分期有哪些？ 结肠癌转移途径有哪些？ 结肠癌高位人群有哪些？ 结肠癌根治性切除手术方法有哪些？ 结肠癌并急性肠梗阻手术治疗原则？ 第37章 结直肠与肛管疾病 117. GEOGRAPHICAL PREVALENCE OF IBD Crohn’s disease and ulcerative colitis have their highest prevalence in Western industrialized countries of Europe and North America. Intermediate prevalence is found in developing countries including post World War II Japan, Korea, Hong Kong, South Africa, and Israel. As new areas assume Western cultural practices, increased prevalence of ulcerative colitis usually is found approximately one decade before the observed increase in Crohn’s disease. The influence of environmental factors is also demonstrated by changes in the incidence and prevalence of IBD when populations move from one area to another. For example, Japanese immigrants to Vancouver have an increased prevalence of disease in the first generation born in North America and Eastern European Jewish settlers in Israel have decreased frequencies of disease in their offspring in Israel. Note that areas of low prevalence of IBD have the highest frequency of indigenous intestinal infections, including helminthic infestations. 222. ILEAL POUCH-ANAL ANASTOMOSIS The ileal pouch-anal anastomosis (IPAA) has become the conventional operation for ulcerative colitis with 90% of procedures for ulcerative colitis in many series involving IPAA. The operation can be done as a primary two stage procedure, a total procto-colectomy, and IPAA with temporary loop ileostomy, multistage with subtotal colectomy, oversow of rectal stump, and ileostomy followed by completion proctectomy and loop ileostomy closure or as a one stage procedure without loop ileostomy. The procedure can be done by a total mucosal proctectomy with hand suturing of the pouch to the anal canal or by leaving the anal transitional zone with stapling of the pouch to the anal canal. Long-term follow-up of pouch function and quality of life have indicated a high degree of success with an acceptable rate of complicat