目的 简化全大肠切除回肠贮袋肛管吻合术，避免全大肠切除术时腹壁回肠造瘘。方法 采用全大肠切除直肠肌鞘内回肠肛管吻合改进术式治疗25例家族性腺瘤性息肉病及1例溃疡性结肠炎患者，并进行了定期随访。结果 术后1年患者的肛门功能恢复正常，大便1～4次/天，可正常参加工作； 除2例发生术后早期不完全性小肠梗阻和1例癌变患者术后发生性功能障碍外无其它并发症。结论 该术式具有技术简单、病变切除彻底、无回肠造袋、不需要回肠造瘘、直视下剥离粘膜完全、止血操作容易、并发症少、术后肛门功能满意等优点。
ObjectiveTo summarize the recent progress in studies of intestinal immunity in inflammatory bowel disease (IBD). MethodsThe literatures on studying the intestinal immunity in IBD, including ulcerative colitis and Crohn disease were reviewed and analyzed. ResultsIBD comprised two main diseases that cause inflammation of the intestines: ulcerative colitis and Crohn disease. Although the diseases had some features in common, there were some important differences in clinical symptoms and pathological features. Accumulating evidence suggested that IBD results from an inappropriate inflammatory response to intestinal microbes in a genetically susceptible host. Immunity studies highlighted the importance of host-microbe interactions in the pathogenesis of these diseases. Prominent among these findings were genomic regions containing nucleotide oligomerization domain 2 (NOD2), autophagy genes, miRNAs, and components of the interleukin-23/type 17 helper T-cell (Th17) pathway. The disfunction of the intestinal microbiome, intestinal epithelium, intestinal immune cells, and the intestinal vasculature played a key role in the process of IBD. The treatment with monoclonal antibody had been introduced to treat IBD and had been certificated effective. ConclusionThe study of basic intestinal immunity and regulation network of molecules in pathogenic process of IBD provides theory basis on prevention of IBD, while related genes of IBD can offer more gene therapy targets.
Objective To assess the efficacy and safety of mesalazine versus sulfasalazine in the treatment of ulcerative colitis.Methods The literatures were searched from PubMed (1966 to January 2010), the Cochrane Library (1966 to January 2010), EMbase (1974 to January 2010), CNKI (1994 to January 2010), VIP (1989 to January 2010), and CBM (1978 to January 2010). The data were extracted, the quality of studies was evaluated according to The Cochrane Handbook, and meta-analyses were performed using RevMan 5.0 software. Results Sixteen RCTs involving 1 333 patients were included in this study. The results of meta-analyses showed that the total effective rate of the mesalazine group was significantly higher than that of the sulfasalazine group (RR=1.10, 95%CI 1.04 to 1.17, Plt;0.05), and significant differences were noted in the total remission rate (RR=1.82, 95%CI 1.14 to 2.91, Plt;0.05), while there was no significant difference in the relapse rate between the two groups (RR=0.86, 95%CI 0.57 to 1.29, Pgt;0.05). Twelve RCTs reported adverse effects and meta-analyses showed that the incidence of adverse effects was significantly lower in the mesalazine group than in the sulfasalazine group (RR=0.56, 95%CI 0.42 to 0.73, Plt;0.05). Conclusion Analyses show that mesalazine is much more effective and safe in the management of ulcerative colitis than sulfasalazine. However, there is a moderate risk of bias due to methodological quality problems in all 16 included RCTs, so more strictly-designed multi-centered randomized controlled trials with high quality in large-scale are needed to confirm this result.
目的 评价注射用英夫利西单抗治疗难治性溃疡性结肠炎（UC） 的疗效。方法 回顾性分析2009年10月至2012年10月期间，在中国医科大学附属第四医院肛肠外科住院并接受注射用英夫利西单抗治疗的9例中重度激素难治性UC患者的临床疗效。结果 经注射用英夫利西单抗治疗后，7例中度UC患者中，1例完全缓解，4例有效，1例疗效不详，1例无效；2例重度UC者中，1例有效，1例无效。临床缓解及治疗有效的6例患者的血红蛋白水平较治疗前上升，红细胞沉降率及C反应蛋白水平均下降。3例具有肠外表现者的肠外症状均得到改善。结论 对于激素抵抗或激素依赖的中重度UC患者，注射用英夫利西单抗可以有效缓解患者的临床症状。
ObjectiveTo investigate the significance of endoscopic punctiform erosion around appendiceal orifice with diffused inflammation in left semicolon in the diagnosis of ulcerative colitis. MethodsTwenty-nine patients with endoscopic punctiform erosion around appendiceal orifice with diffused inflammation in left semicolon treated in West China Hospital from January 2007 to November 2012 were included in our study.Patients with either edema,ulcer,polyps around the appendiceal orifice,inflammation in the ascending colon or transverse colon,or segmental inflammation in left semicolon were excluded.The endoscopic characteristic changes and the final diagnosis were compared by means of the pathological biopsy. ResultsOf the total 29 patients with characteristic changes under the endoscope,26 patients were eventually diagnosed to have left-sided ulcerative colitis,one was identified to be with Cronh's disease,and the remaining two patients could not be classified. ConclusionOur findings suggest that the characteristic changes under the endoscope may help the diagnosis of ulcerative colitis.
目的 针对近期收治的1例常规治疗疗效不理想的溃疡性结肠炎患者,我们进行了证据检索和评价,以期找到更有效的治疗方法.方法 计算机检索MEDLINE(1978～2004)、CBMdisc(1978～2004)及Cochrane图书馆(2004年第3期),查找 5-氨基水杨酸(5-ASA)灌肠液治疗溃疡性结肠炎及与病情缓解有关的系统评价、临床随机对照试验等,并对所获证据进行评价.结果 高质量的临床证据表明,5-ASA灌肠液治疗溃疡性结肠炎及帮助病情缓解均优于口服5-ASA及柳氮磺胺嘧啶局部灌肠治疗.据此临床证据,结合医生经验及病人意愿,对该例患者实施5-ASA 1g+生理盐水100 ml qd,睡前保留灌肠治疗.1周后,患者临床症状明显缓解,腹泻基本停止,每天解黄色黏液便1～2次.肠镜复查,炎症较前明显减轻.出院后继续用上述方案维持治疗,每周2次.门诊随访1年,患者未再复发,也无明显副作用发生.结论 5-ASA灌肠液是控制溃疡性结肠炎活动期间病情及帮助缓解、减少复发的有效药物.
【摘要】 目的 采用循证医学的方法评价硫唑嘌呤（aiathioprine，AZA）治疗溃疡性结肠炎（ulcerative colitis，UC）的有效性和安全性。 方法 计算机检索PubMed、Cochrane library、Embase、CNKI、维普和CBM数据库收集国内外关于AZA诊疗UC的随机对照试验（ramdomized controllel trial，RCT）。按Cochrane系统评价的方法评价纳入研究质量，并进行Meta分析。 结果 共纳入5个RCT，共262例UC患者。Meta分析结果显示，AZA治疗UC在缓解率方面与安慰剂比较，差异无统计学意义[P=1.19，95%CI（0.94，1.49），P=0.14]；在复发率方面，两者比较差异有统计学意义[P=0.72，95%CI（0.54，0.95），P=0.02]；全部不良反应方面和严重不良反应方面，两者比较差异无统计学意义，Meta分析结果分别为[P=2.52，95%CI（0.82，7.74），P=0.11]和[P=4.03，95%CI（0.88，18.53），P=0.07]。 结论 系统评价结果为AZA在疗效方面优于安慰剂，在不良反应发生率方面差异无统计学意义。但由于纳入的5个研究中没有高质量的RCT，且有1个可能产生高度偏倚，使得这一结论受到影响，有必要开展更多设计严谨，大样本、多中心的RCT。【Abstract】 Objective To assess the efficacy and safety of azathio-prine in the treatment of ulcerative colitis through an evidence-based method. Methods We searched the literature from databases like PubMed, Cochrane library, CNKI, VIP, and CBM, and evaluated the quality of studies according to Cochrane systematic review. Finally, Meta-analysis was performed. Results Five randomized controlled trials (RCT) were included in this study with a total of 262 patients. Meta-analysis showed that there was no significant difference in the rate of remission between azathio-prine and placebo in treating ulcerative colitis [P=1.19, 95%CI (0.94, 1.49),P=0.14]. There was significant difference in the relapse rate between the two treating methods [P=0.72, 95%CI (0.54, 0.95),P=0.02]. In addition, there was no statistical difference in all adverse effects [P=2.52, 95%CI (0.82, 7.74),P=0.11] and serious adverse effects [P=4.03, 95%CI (0.88, 18.53),P=0.07] between the two treating methods. Conclusion In the treatment of ulcerative colitis, azathio-prine has a significant advantage in efficacy than placebo, but there is no significant difference in the rate of adverse events between the two groups. However, none of the 5 RCT included in this review has a high quality and one of them even probably has a high bias, which has a big influence on our conclusion. Consequently, multi-center large-scale randomized controlled trials of higher quality are needed to make confirmation.