切换至 "中华医学电子期刊资源库"

中华临床医师杂志(电子版) ›› 2021, Vol. 15 ›› Issue (11) : 814 -818. doi: 10.3877/cma.j.issn.1674-0785.2021.11.003

专家论坛

溃疡性结肠炎相关结直肠癌的外科治疗
何安琪1, 刘刚1,()   
  1. 1. 300052 天津,天津医科大学总医院普通外科
  • 收稿日期:2021-07-19 出版日期:2021-11-15
  • 通信作者: 刘刚

Surgical management of ulcerative colitis related colorectal cancer

Anqi He1, Gang Liu1,()   

  1. 1. Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
  • Received:2021-07-19 Published:2021-11-15
  • Corresponding author: Gang Liu
引用本文:

何安琪, 刘刚. 溃疡性结肠炎相关结直肠癌的外科治疗[J]. 中华临床医师杂志(电子版), 2021, 15(11): 814-818.

Anqi He, Gang Liu. Surgical management of ulcerative colitis related colorectal cancer[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(11): 814-818.

溃疡性结肠炎(UC)是慢性非特异性肠道炎症性疾病,长期反复炎症刺激下的上皮细胞损伤、修复和增殖使UC患者具有更高肠道黏膜癌变风险。溃疡性结肠炎相关性结直肠癌(UC-CRC)是UC的重要并发症,也是其外科手术治疗的绝对适应证。全结直肠切除、回肠贮袋肛管吻合术(IPAA)是治疗UC的标准术式,也适用于经过筛选的UC-CRC患者。UC-CRC外科治疗应以肿瘤根治原则为基石,结合UC疾病特点和患者全身状况对每例患者进行个体化的治疗方案制定,是改善肿瘤预后并提高生活质量的总体策略。

Ulcerative colitis (UC) is a chronic nonspecific inflammatory disease of the intestine. The damage, repair, and proliferation of epithelial cells stimulated by long-term recurrent inflammation put UC patients at a higher risk of intestinal mucosal carcinogenesis. Ulcerative colitis related colorectal cancer (UC-CRC) is an important complication of UC, as well as an absolute indication for surgical treatment. Total colorectal resection and ileal pouch anal anastomosis are the standard surgeries for UC, and are also applicable to the screening of UC-CRC cases. Guided by the principles of radical tumor surgery and based on the disease characteristics and medical conditions, individualized treatment plan should be formulated to improve the prognosis and quality of life of UC-CRC patients.

1
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin, 2021, 71(3): 209-249.
2
Fumery M, Dulai PS, Gupta S, et al. Incidence, risk factors, and outcomes of colorectal cancer in patients with ulcerative colitis with low-grade dysplasia: a systematic review and Meta-analysis [J]. Clin Gastroenterol Hepatol, 2017, 15(5): 665-674.
3
中华医学会消化病学分会炎症性肠病学组. 炎症性肠病诊断与治疗的共识意见 (2018年,北京) [J]. 中华消化杂志, 2018, 38(5): 292-311.
4
Keller DS, Windsor A, Cohen R, et al. Colorectal cancer in inflammatory bowel disease: review of the evidence [J]. Tech Coloproctol, 2019, 23(1): 3-13.
5
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, 11(6): 649-670.
6
Choi CH, Ignjatovic-Wilson A, Askari A, et al. Low-grade dysplasia in ulcerative colitis: risk factors for developing high-grade dysplasia or colorectal cancer [J]. Am J Gastroenterol, 2015, 110(10): 1461-1472.
7
Oresland T, Bemelman WA, Sampietro GM, et al. European evidence based consensus on surgery for ulcerative colitis [J]. J Crohns Colitis, 2015, 9(1): 4-25.
8
Shen B, Fazio VW, Remzi FH, et al. Risk factors for diseases of ileal pouch-anal anastomosis after restorative proctocolectomy for ulcerative colitis [J]. Clin Gastroenterol Hepatol, 2006, 4(1): 81-89, quiz 2-3.
9
Zmora O, Spector D, Dotan I, et al. Is stapled ileal pouch anal anastomosis a safe option in ulcerative colitis patients with dysplasia or cancer? [J]. Int J Colorectal Dis, 2009, 24(10): 1181-1186.
10
Wu XR, Kiran RP, Remzi FH, et al. Preoperative pelvic radiation increases the risk for ileal pouch failure in patients with colitis-associated colorectal cancer [J]. J Crohns Colitis, 2013, 7(10): e419-e426.
11
Wertzberger BE, Sherman SK, Byrn JC. Differences in short-term outcomes among patients undergoing IPAA with or without preoperative radiation: a National Surgical Quality Improvement Program analysis [J]. Dis Colon Rectum, 2014, 57(10): 1188-1194.
12
Chang BW, Kumar AM, Koyfman SA, et al. Radiation therapy in patients with inflammatory bowel disease and colorectal cancer: risks and benefits [J]. Int J Colorectal Dis, 2015, 30(3): 403-408.
13
Sensi B, Bagaglini G, Bellato V, et al. Management of low rectal cancer complicating ulcerative colitis: proposal of a treatment algorithm [J]. Cancers (Basel), 2021, 13(10): 2350.
14
Morowitz DA, Kirsner JB. Ileostomy in ulcerative colitis. A questionnaire study of 1,803 patients [J]. Am J Surg, 1981, 141(3): 370-375.
15
Scoglio D, Ahmed AU, Fichera A. Surgical treatment of ulcerative colitis: ileorectal vs ileal pouch-anal anastomosis [J]. World J Gastroenterol, 2014, 20(37): 13211-13218.
16
Fornaro R, Casaccia M, Caristo G, et al. Elective surgery for ulcerative colitis, ileo-rectal anastomosis or restorative proctocolectomy an update [J]. Ann Ital Chir, 2019, 90: 565-573.
17
Karjalainen EK, Renkonen-Sinisalo L, Lepisto AH. Dysplasia in the mucosal biopsy specimen is still a warning sign of cancer in ulcerative colitis [J]. Scand J Gastroenterol, 2020, 55(9): 1019-1023.
18
Zhang C, Cui M, Xing J, et al. Clinicopathologic features and prognosis of synchronous and metachronous multiple primary colorectal cancer [J]. Clin Transl Oncol, 2021, 23(2): 335-343.
19
Warps AK, Detering R, Dekker J, et al. A 10-year evaluation of short-term outcomes after synchronous colorectal cancer surgery: a dutch population-based study [J]. J Gastrointest Surg, 2021, 25(10):2637-2648.
20
Barz C, Stoss C, Neumann PA, et al. Retrospective study of prognosis of patients with multiple colorectal carcinomas: synchronous versus metachronous makes the difference [J]. Int J Colorectal Dis, 2021, 36(7): 1487-1498.
21
Merchea A, Wolff BG, Dozois EJ, et al. Clinical features and oncologic outcomes in patients with rectal cancer and ulcerative colitis: a single-institution experience [J]. Dis Colon Rectum, 2012, 55(8): 881-885.
22
Anderson R, Burr NE, Valori R. Causes of post-colonoscopy colorectal cancers based on world endoscopy organization system of analysis [J]. Gastroenterology, 2020, 158(5): 1287-1299.
23
Stjarngrim J, Ekbom A, Hammar U, et al. Rates and characteristics of postcolonoscopy colorectal cancer in the Swedish IBD population: what are the differences from a non-IBD population? [J]. Gut, 2019, 68(9): 1588-1596.
24
Forsberg A, Widman L, Bottai M, et al. Postcolonoscopy colorectal cancer in sweden from 2003 to 2012: survival, tumor characteristics, and risk factors [J]. Clin Gastroenterol Hepatol, 2020, 18(12): 2724-2733.
25
Hardt J, Kienle P. Occult and manifest colorectal carcinoma in ulcerative colitis: how does it influence surgical decision making? [J]. Viszeralmedizin, 2015, 31(4): 252-257.
26
中华医学会消化病学分会炎症性肠病学组. 炎症性肠病外科治疗专家共识 [J]. 中华炎性肠病杂志, 2020, 4(3): 180-199.
27
Snelgrove R, Brown CJ, O'Connor BI, et al. Proctocolectomy for colorectal cancer--is the ileal pouch anal anastomosis a safe alternative to permanent ileostomy? [J]. Int J Colorectal Dis, 2014, 29(12): 1485-1491.
28
Remzi FH, Preen M. Rectal cancer and ulcerative colitis: does it change the therapeutic approach? [J]. Colorectal Dis, 2003, 5(5): 483-485.
29
刘刚, 刘彤. 重症溃疡性结肠炎的外科治疗策略 [J]. 中华消化外科杂志, 2018, 17(9): 896-900.
30
Derikx LA, Kievit W, Drenth JP, et al. Prior colorectal neoplasia is associated with increased risk of ileoanal pouch neoplasia in patients with inflammatory bowel disease [J]. Gastroenterology, 2014, 146(1): 119-128.
31
Derikx L, Nissen L, Smits L, et al. Risk of neoplasia after colectomy in patients with inflammatory bowel disease: a systematic review and Meta-analysis [J]. Clin Gastroenterol Hepatol, 2016, 14(6): 798-806.
32
Lightner AL, Vaidya P, Vogler S, et al. Surveillance pouchoscopy for dysplasia: cleveland clinic ileoanal pouch anastomosis database [J]. Br J Surg, 2020, 107(13): 1826-1831.
33
Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis [J]. Br Med J, 1978, 2(6130): 85-88.
34
Lovegrove RE, Constantinides VA, Heriot AG, et al. A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients [J]. Ann Surg, 2006, 244(1): 18-26.
35
Kirat HT, Remzi FH, Kiran RP, et al. Comparison of outcomes after hand-sewn versus stapled ileal pouch-anal anastomosis in 3,109 patients [J]. Surgery, 2009, 146(4): 723-730.
36
Nobel T, Khaitov S, Greenstein AJ. Controversies in J pouch surgery for ulcerative colitis: a focus on handsewn versus stapled anastomosis [J]. Inflamm Bowel Dis, 2016, 22(9): 2302-2309.
37
Dignass A, Preiss JC, Aust DE, et al. Updated German guideline on diagnosis and treatment of ulcerative colitis, 2011 [J]. Z Gastroenterol, 2011, 49(9): 1276-1341.
38
Remzi FH, Fazio VW, Delaney CP, et al. Dysplasia of the anal transitional zone after ileal pouch-anal anastomosis: results of prospective evaluation after a minimum of ten years [J]. Dis Colon Rectum, 2003, 46(1): 6-13.
39
Olen O, Erichsen R, Sachs MC, et al. Colorectal cancer in ulcerative colitis: a Scandinavian population-based cohort study [J]. Lancet, 2020, 395(10218): 123-131.
40
Ali RA, Dooley C, Comber H, et al. Clinical features, treatment, and survival of patients with colorectal cancer with or without inflammatory bowel disease [J]. Clin Gastroenterol Hepatol, 2011, 9(7): 584-589.
41
Reynolds IS, O'Toole A, Deasy J, et al. A meta-analysis of the clinicopathological characteristics and survival outcomes of inflammatory bowel disease associated colorectal cancer [J]. Int J Colorectal Dis, 2017, 32(4): 443-451.
[1] 张剑明, 叶文慧, 牟廷裕, 蓝孝亮, 邓海军. 腹腔镜全结直肠切除、回肠J型储袋-肛管吻合术近期并发症及防治策略[J]. 中华结直肠疾病电子杂志, 2023, 12(05): 388-395.
[2] 陈润芝, 杨东梅, 徐慧婷. 信迪利单抗联合索凡替尼后线治疗MSS型BRAF突变的转移性结肠癌:个案报道并文献复习[J]. 中华结直肠疾病电子杂志, 2023, 12(05): 431-435.
[3] 鄂一民, 孙司正, 范小彧, 喻春钊. 结直肠癌粪便筛查的现状与展望[J]. 中华结直肠疾病电子杂志, 2023, 12(04): 331-336.
[4] 王小娜, 谭微, 李悦, 姜文艳. 预测性护理对结直肠癌根治术患者围手术期生活质量、情绪及并发症的影响[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 525-529.
[5] 梁文龙, 曹杰, 黄庆, 林泳, 黄红丽, 杨平, 李冠炜, 胡鹤. 信迪利单抗联合瑞戈非尼治疗晚期结直肠癌的疗效与安全性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 409-413.
[6] 屈霄, 王靓, 陆萍, 何斌, 孙敏. 外周血炎症因子及肠道菌群特征与活动性溃疡性结肠炎患者病情的相关性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 466-470.
[7] 刘代江, 蒋俊艳, 万晓强, 马莎英. 结直肠癌肝转移患者生存状况及预后影响因素分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 284-288.
[8] 朱风尚, 舍玲, 丁永年, 杨长青. 警惕炎症性肠病与少见肠道疾病的鉴别诊断[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 273-276.
[9] 陈婷婷, 江学良, 余佳丽, 柯剑林. 干细胞治疗炎症性肠病的安全性[J]. 中华消化病与影像杂志(电子版), 2023, 13(04): 193-198.
[10] 李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[11] 王飞飞, 王光林, 孟泽松, 李保坤, 曹龙飞, 张娟, 周超熙, 丁源一, 王贵英. 敲低IMPDH1对结肠癌SW480、HT29细胞生物功能的影响[J]. 中华临床医师杂志(电子版), 2023, 17(08): 884-890.
[12] 孔凡彪, 杨建荣. 肝脏基础疾病与结直肠癌肝转移之间关系的研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(07): 818-822.
[13] 王亚丹, 吴静, 黄博洋, 王苗苗, 郭春梅, 宿慧, 王沧海, 王静, 丁鹏鹏, 刘红. 白光内镜下结直肠肿瘤性质预测模型的构建与验证[J]. 中华临床医师杂志(电子版), 2023, 17(06): 655-661.
[14] 王延召, 牛鹏飞, 丁长民, 高庆坤, 高兆亚, 安柯, 翟志超, 曾庆敏, 黄文生, 雷福明, 顾晋. 结直肠癌致腹壁巨大缺损的一期修补经验(附13例报告)[J]. 中华临床医师杂志(电子版), 2023, 17(05): 557-561.
[15] 任鹏涛, 郝英豪, 阮红训, 秦晓宁, 张苑, 李猛. Lnczc3h7a靶向CTHRC6对肠癌细胞的增殖和迁移的影响[J]. 中华临床医师杂志(电子版), 2023, 17(03): 320-325.
阅读次数
全文


摘要