UC手术治疗课件.pptVIP

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 (41 – 64 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 (18 – 40 yr),middle-age adults (41 – 64 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 Study[J]. 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 disorders[J]. 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 Study[J]. 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 ins