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Effectiveness of surgical treatment on colonic Crohn’s disease

ObjectiveTo elucidate the characteristics of colonic Crohn’s disease (CD) and evaluate effectiveness of surgical treatment.MethodClinical data of 28 cases with colonic CD who underwent surgery at West China Hospital of Sichuan University between Feb. 2009 and Jan. 2017 were retrospectively analyzed.ResultsDefinite diagnosis of colonic CD was performed in 12 cases preoperatively (42.9%), but 16 cases (57.1%) were misdiagnosed as other disease, ulcerative colitis (5 cases, 17.9%), tumor (4 cases, 14.3%), appendiceal disease (4 cases, 14.3%), and intestinal tuberculosis (3 cases, 10.7%) were the major causes of preoperative misdiagnosed disease. Of the 28 cases, elective surgery was performed in 26 cases and emergency surgery in 2 cases. The major surgical procedures were segmental colectomy(10 cases) and right hemicolectomy (6 cases), as well as ilecolostomy (9 cases), colocolostomy(6 cases), ileostomy(9 cases), colostomy (6 cases), and so on. The length of the first hospital stay of operation related to intestinal lesions in this group was 5–74 d (mean of 25.4 d). Postoperative complications were occurred in 9 cases (32.1%), all these cases didn’t receave medical treatment. Twenty cases were followed up, and the follow-up time was 7–78 months (mean of 33.4 months), 8 cases lost follow-up. The prognosis of the follow-up cases was good.ConclusionsColonic CD has occult clinical manifestation, resulting in misdiagnosis and mistreatment. Segmental resection of the colon is the important treatment for colonic CD. For patients with complications, multidisciplinary diagnosis and treatment is necessary. In addition, systematic medical treatment before surgery helps to reduce the risk of the first surgery associated with intestinal lesions.

Colorectal Cancer in Inflammatory Bowel Disease

The Double-Stapled Ileal Pouch-Anal Anastomosis in Treatment of Ulcerative Colitis（ Reports of 11 Cases）

目的　探讨双吻合器法回肠储袋肛管吻合治疗溃疡性结肠炎的临床疗效。方法　回顾性分析采用双吻合器法回肠储袋肛管吻合治疗11例溃疡性结肠炎患者的临床资料。 结果　手术时间（4.5±1.7）h（2.5～6.0h）， 出血量（470±120）ml （200～800ml），住院时间（16±5.9） d （14～27d）。所有患者均获随访，随访时间为（31.3±5.7）个月（6～42个月）。 随访期内肛门功能恢复满意；主要并发症包括切口相关并发症5例，腹痛伴间断便血4例，储袋炎4例，肠梗阻3例，吻合口漏1例。 结论　双吻合法回肠储袋肛管吻合是治疗溃疡性结肠炎的有效手段，合理选择手术时机及方式可有效降低术后并发症的发生。

溃疡性结肠炎80例治疗及护理观察

目的:分析总结溃疡性结肠炎的治疗方法和效果及护理特点。方法:通过柳氮磺胺吡啶和琥珀氢化可的松口服、保留灌肠或静脉滴注治疗80例溃疡性结肠炎患者,比较用药前后症状和大便的变化。结果:用药后腹泻、腹胀明显减轻,大便中WBC、RBC、脓细胞减少。结论:柳氮磺胺吡啶和琥珀氢化可的松能迅速减轻该病的症状。

Surgical Treatment for Ulcerative Colitis

Expressions and significances of interleukin-6 and microsatellite instability in ulcerative colitis-associated colorectal cancer

ObjectiveTo analyze expressions of interleukin-6 (IL-6) and microsatellite instability (MSI) in ulcerative colitis-associated colorectal cancer (UC-CRC) and investigate role of IL-6 and MSI in carcinogenesis of patients with UC.MethodsThe postoperative pathological data of patients with UC-CRC and patients with sporadic colorectal cancer (SCRC) admitted by Edong Healthcare Group from January 2013 to January 2019 were analyzed retrospectively. The expressions of MMR proteins, including hMLH1, hPMS2, hMSH2, and hMSH6, were detected by the immunohistochemical method. The serum IL-6 levels of the patients with UC, UC-CRC, SCRC and control patients (non-UC, non-UC-CRC, non-SCRC) were detected. The correlation between the IL-6 and MMR protein expression in the cancer tissue was analyzed.ResultsThere were 43 patients with UC, 17 UC-CRC, 55 SCRC, and 30 control patients. The total rate of MMR-deficient (dMMR) was 41.2% (7/17) in the patients with UC-CRC. There were significant correlations between the hMLH1 and hPMS2 protein expression deletion and between the hMSH2 and hMSH6 protein expression deletion (P<0.001). The serum level of IL-6 in the patients with UC-CRC was significantly higher than that in the patients with UC (t=4.97, P<0.001) and the patients with SCRC (t=5.26, P=0.006). The dMMR might be associated with the level of IL-6 in the patients with UC-CRC, which wasn’t associated with it in the patients with SCRC (rs=0.04, P=0.77).ConclusionsSimilar to SCRC, MSI also plays a role in occurrence and development of UC-CRC. dMMR in patient with UC-CRC is more common in co-expression deficiency of hMLH1 and hPMS2, as did hMSH2 and hMSH6. IL-6 is not involved in mechanism of MSI-related canceration of colorectal cancer, but it is speculated that IL-6 might be involved in occurrence of MSI of UC-CRC.

英夫利昔单抗治疗难治性溃疡性结肠炎疗效观察

目的观察英夫利昔单抗治疗难治性溃疡性结肠炎的疗效。 方法将2010年2月－2012年5月收治的70例难治性溃疡性结肠炎患者随机分为治疗组和对照组，每组各35例。两组均给予常规治疗（复方谷氨酰胺、双歧杆菌三联活菌、泼尼松等），治疗组在常规治疗的基础上给予英夫利昔单抗5 mg/（kg·d）加入生理盐水100 mL于2 h内滴完，于治疗起始、第2周、第6周应用，随后每隔8周给予相同剂量以维持缓解，疗程为1年；对照组在常规治疗的基础上给予硫唑嘌呤1.5～2.0 mg/（kg·d）、1次/d口服治疗。 结果治疗组总有效率94.2%，对照组总有效率62.8%，差异有统计学意义（χ2=10.267，P=0.001）。两组均未出现明显不良反应。 结论英夫利昔单抗治疗难治性溃疡性结肠炎具有较好的疗效，无明显不良反应。

锡类散思密达治疗溃疡性结肠炎伴不典型增生研究

摘要:目的:锡类散思密达联合治疗溃疡性结肠炎伴不典型增生临床疗效观察。方法:锡类散思密达保留灌肠每晚一次,治疗4周后复查。结果:临床完全缓解32例,有效8例,无效2例,有效率95.23%;结肠镜下治疗后较治疗前明显改善,组织病理从治疗前轻度38例、中度4例治疗后无不典型增生30例、轻度10例、中度2例改变。结论:锡类散思密达治疗溃疡性结肠炎,疗效确切,症状改善快,副作用小。

不同微泵更换方式在重度溃疡性结肠炎患者激素冲击治疗中的药物残留比较

目的探讨两种不同微泵更换的方式，对重度溃疡性结肠炎患者泵入琥珀氢化可的松行激素冲击治疗药物剂量的影响。 方法2011年6月－2012年6月对20例行激素冲击治疗的溃疡性结肠炎患者，采用便利采样的方法分为2组，分别采用传统更换法（传统组）和改良更换法（改良组）泵入琥珀氢化可的松，比较不同更换方式在1个疗程时空针与导管内的药物残留量。 结果改良组更换法1个疗程后其空针内及压力延长管内药物残留量为0 mg，传统组为（81.5±33.2）mg，两组比较差异有统计学意义（t=8.573，P＜0.001）。 结论改良组更换法能保证激素冲击治疗重度活动期溃疡性结肠炎患者治疗剂量的准确。

The Significance of Endoscopic Punctiform Erosion around Appendiceal Orifice with Diffused Inflammation in Left Semicolon in the Diagnosis of Ulcerative Colitis

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.