UC手术治疗.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2019/2/27,.,#,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,.,1,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,.,2,surgery,FIGURE 1.Cumulative risk of surgery related to IBD among patients with UC stratified by age at diagnosis as young adults(1840 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 N,guyen 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.,.,3,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 T,onelli 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.,.,4,laparoscopic VS open,.,5,1 M,agro 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.,.,6,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:A Case-matched Comparative StudyJ.Surg Laparosc Endosc Percutan Tech.2015,25(5):424-429.,.,7,我科腹腔镜手术在结直肠外科的运用,直肠,左半结肠,横结肠,右半结肠,.,8,TA-TME,CompleteLaparoscopic,.,9,内外结合,共创双赢,.,10,