Результаты хирургического лечения болезни Крона и неспецифического язвенного колита Текст научной статьи по специальности «Клиническая медицина»

II. ХИРУРГИЯ

МРНТИ 76.29.29

THE RESULTS OF SURGICAL TREATMENT OF CROHN'S DISEASE AND NONSPECIFIC ULCERATIVE COLITIS

ABOUT THE АUTHORS

Kuliyeva Ainur -

Junior Researcher, Department of Coloproctology, sevilmm@rambler.ru

Imanova Nargiz -

researcher, Department of Coloproctology.

Mamedov Maharram -

Professor, Head of the Department of Coloproctology,

Aliyev Kamal -

Junior Researcher, Department of Coloproctology.,

Aliyeva Aygun -

MD, department of endoscopy

Keywords

Crohn's disease, Nonspecific Ulcerative Colitis, colonoscopy, reservoir from the intestinal loop.

Kuliyeva A.E., Imanova N.J., Mammadov M.M., Aliyeva K.A., Aliyeva A.O.

Colorectal surgery department,

Scientific Centre of Surgery named after Topchubashov M.A., Baku, Azerbaijan

Abstract

The purpose of the study was to improve the results of surgical treatment of patients with Crohn's disease and ulcerative colitis. Materials and methods: In the period from 2007 to 2015, 170 patients were hospitalized, 109 were diagnosed with Crohn's disease and 61 patients were diagnosed with ulcerative colitis. 48 patients were operated on (38 patients with Crohn's disease and 10 patients with non-specific ulcerative colitis) aged 16 to 58 years. Of these, 4 patients were operated using by laparoscopic method and 44 using by open method. Three groups were created: in the first group, 14 patients: 11 (22.9%) underwent total colectomy with formation of a reservoir from the small intestinal loop and 3 patients (6.3%) had a temporary ileostomy. In the second group there were 8 patients: in 2 (4.2%) resection of the small intestine with the imposition of the small intestinal anastomosis, and in 6 (12.5%) patients, right-sided hemicolectomy + ileotransversely. In the third group of 24 patients: 12 patients (25%) total proctocolectomy + terminal ileostomy and 12 patients (25%) subtotal proctocolectomy + terminal ileostomy. Results: reconstructive surgery provided an opportunity to improve the objective assessment of the severity of the disease, reduce the occurrence of complications, optimize the results of surgical treatment and reduce the rates of disease recurrence as well as postoperative complications and mortality. In patients of the first group (total colectomy with the formation of a reservoir from the small intestinal loop), the quality of life becomes better compared with other groups.

Крон ауруы мен арнайы емес колиттщ хирургиялык емдеудщ нэтижелерi

АВТОРЛАР ТУРАЛЫ

Кулиева Айнур -

Колопроктология бел1мшесшц кш FbrnbiMn кызметкер. sevllmm@rambbr.ru

Иманова Наргиз -

Колопроктология бел1мшес1н1ц Fылыми кызметкер.

Мамедов Магеаррам -

профессор, колопроктология бел1м1н1ц мецгерушс,

Алиева Камаля -

Fылыми кызметкер, колопроктологии бел!м1.

Алиева Айгюн -

эндоскопия бел1мшес1н1ц дэрйер!

Туйш сездер

спецификалык емес ойыкжара колил, Крон ауруы, жука ¡шектен лмек жасалган резервуары, колоноскопия

Кулиева А.Е., Иманова Н.Ж., Мамедов М.М., Алиева К.А., Алиева А.О.

М.А. Топчубашов атында?ы ?ылыми хирургия орталы^ы, Колоректальды хирургия бeлiмi, Баку к,., Эзiрбайжан

Ацдатпа

Зерттеу мацсаты: Крон ауруына жэне арнайы емес колит1не шалдыккан ауруларды хирургиялык емдеу нэтижелер1н жаксарту болып табылады. Материалдары мен эд'ютер'/: 2007 жылдан бастап 2015 жылга дей1нп мерз1м1нде стационарлык 170 ауру ем алган, соныц ¡ш/нде 109 пациент Крон ауруына жэне 61 пациент арнайы емес колилне шалдыккандар болган. Сондай аурулардыц 48-не ота жасалган 16 жастан 58 жаска дей1нп мелшер1ндеп (38 пациент Крон ауруына жэне 10 пациент спецификалык емес ойыкжара колилне шалдыккандар). Соныц iшнен 4 ауруга лапароскопиялык эд1с1мен жэне 44 ауруга ашык тур1нде ота жасалган. 3 топ курылган: б1р1нш'1 топта 14 аурудыц: 11-iнде (22,9%) жука шектен лмекжасап, резервуар калыптастырып, жаппай колэк-томия отасы жасадган, ал 3 ауруга (6,3%) уакытша илеостома эдiсi колданып, салынган. Екiншi топта 8 ауру: 2-не (4,2%) жука iшек аркылы анастомоз салынып, жука шектщ резекциялау отасы жасалган, ал аурулардыц 6-ына (12,5%) оцжактык гемиколэктомия+илеотранверзостомия отасы жасалган. Yшiншi топта 24 аурудыц: 12 ауруга (25%) жаппай проктоколэктомия+терминалды илеостомия жасалып, ал 12 ауруга (25%) субтотальдык про-ктоколэктомия+ терминалдык илеостомия э^амен ота жасалган. Нэтижелер'/: реконструктивтк пен бурынгы калпына келлру тургысынан оталар аурудыц ауырлыгын объективт турде багалауын жаксартуга, кабынулардыц шы^уын азайтуга, хирургиялык емдеу нэтижелерiн онтайландыруга, аурулардыц рецидивтерШц керсеткiштерiн азайтуга, сондай-ак отадан кейiнгi аскынуларды жэне де елiм-жiтiм окигаларын темендетуге ыкпалын типзд. Бiрiншi топтагы аурулардыц (жука iшектен лмек жасап, резервуар калыптастырып, жаппай колэктомия отасы жасагандардыц) баска топтармен салыстырганда, емiр суру сапасы артыгырак болуда.

Результаты хирургического лечения болезни Крона и неспецифического язвенного колита

Кулиева А.Е., Иманова Н.Я., Мамедов М.М., Алиева К.А., Алиева А.О.

Отделение колоректальной хирургии

Научного центра хирургии им. Топчубашов М.А., Баку, Азербайджан Аннотация

Цель исследования была улучшить результаты хирургического лечения больных с болезнью Крона и неспецифическим язвенным колитом. Материалы и методы: В период с 2007 по 2015 годы на стационарном лечение находились 170 больных, 109 с диагнозом болезни Крона и 61 больных с диагнозом неспецифического язвенного колита. Было оперировано 48 больных (38 больных с болезнью Крона и 10 больных с неспецифичеким язвенным колитом) в возрасте от 16 до 58 лет. Из них 4 больных были оперированы лапароскопическим методом и 44 открытым методом. Было создано 3 группы: в первой группе 14 больных: у 11 (22,9%) произведена тотальная колэктомия с формированием резервуара из тонкокишечной петли и у 3-х больных наложена (6,3%) временная илеостома. Во второй группе 8 больных: у 2-х (4,2%) резекция тонкой кишки с наложением тонкокишечного анастомоза и у 6-и (12,5%) больных правосторонная гемиколэктомия+илеотранверзостомия. В третьей группе 24 больных: 12 больных (25%) тотальная проктоколэктомия+терминальная илеостомия и 12 больных (25%) субтотальная проктоколэктомия+ терминальная илеостомия. Результаты: реконструктивно-восстановительные операции дали возможность улучшить объективное оценивание тяжести заболевания, уменьшить возникновения осложнений, оптимизировать результаты хирургического лечения и уменьшить показателей рецидивов заболеваний а также послеоперационных осложнений и смертности. У больных первой группы (тотальная колэктомия с формированием резервуара из тонкокишечной петли) качество жизни становится лучше по сравнению с другими группами.

ОБ АВТОРАХ

Кулиева Айнур -

младший научный сотрудник, отделение

колопроктологии,

sevilmm@rambler.ru

Иманова Наргиз -

научный сотрудник, отделение колопрок-тологии.

Мамедов Магеррам -

профессор, заведующий отделением колопроктологии,

Алиева Камаля -

младший научный сотрудник, отделение колопроктологии.,

Алиева Айгюн -

врач, отделение эндоскопии

Ключевые слова

болезнь Крона, неспецифический язвенный колит, колоноскопия, резервуар из кишечной петли

Background

Diagnose and treatment of Crohn's disease and Nonspecific Ulcerative Colitis which occurs mostly in developed countries nowadays is an actual problem in coloproctology. Doctors and researchers don?t know what causes both diseases, but they speculate that a number of factors such as genetics, heredity, mucosal immunity, gut microbes, diet, environmental factors, vascular problems, psychosocial problems, and certain drugs may be triggers that may participate in causing these diseases [3]. Because the diseases have unknown causes, it is difficult to know what triggers their development. However, if you carefully note in a diary when symptoms reappear in Crohn's disease or worsen in UC, you may be able to identify triggers that affect your disease [3].

About 11,2 million people were affected as of 2015 with Crohn's disease and Nonspecific Ulcerative Colitis [5]. Often it begins in people aged 15 to 30 years or among those over 60 [8]. Males and females appear to be affected in equal proportions [4].It is common to use colonoscopy, histology and radiology to diagnose Crohn's disease and Nonspecific Ulcerative Colitis. The literature indicates that there are different tactics of treatment of Crohn's disease and Nonspecific Ulcerative Colitis (chemotherapy, surgical treatment, combined method etc.) [1, 2, 6, 7] People over age 50 that need surgery have increased mortality due to colitis-associated postoperative complications [3]. Therefore the

pharmacologicaltherapy and surgical tacticsof this disease still need to be improved.

The aim of research is to improve the results of the surgical treatment of the patients with Crohn's disease and Nonspecific Ulcerative Colitis.

Material and methods

In period of 2007-2015 years 109 patients with Crohn's disease and 61 patients with Nonspecific Ulcerative Colitis (common 170 patients) were treated in colorectal surgery department. All patients had check up diagnostic and colonoscopy, histology, CT or MRT. 48 of them (28,24%) were operated. 4 of them (8,3%) were operated laparo-scopically and the rest (44 p. - 91,7%) were operated in open way. 21patients (43,8%) were man and 27 patients(56,2%) were woman. The ages of the patients were between 16-58 years (average age - 30y12,7). 2 patients (5.3%) were operated with the isolated segmental intestinal defect, 11 patients (5.3%) with the ileocecal valve defect+ulcerative lesion (cancer) of the intestinal and colon walls and 26 patients (47.4%) were with the multiple segmental coliculcerative and erosive lesion combined with the total rectal defect.

The absolute indications to operation were: perforation of intestine walls, intestinal bleeding, the toxic colon dilation, inflammatory infiltration, intestine or colon strictures, deep perianal defects, the heavy chronic recurrence and acute lightning forms of Crohn's disease, inflammatory infiltrates, severe

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changes of mucosa ( multiple ulcers and fissures), inflammated pseudopolyps, without remission chronic form of disease, noneffective pharmacotherapy or non treatable patients due to side medicament's effects and colon or intestine cancer.

All patients were operated on conditionally radical, restorational, reconstructive - restorational method.The patients were in 3 groups: First group (14 p.) includedll (22,9%) patients, which had total proctocolectomy + reconstruction of the reservoir from the intestinal loop, 3 patients (6,3%) had temporary ileostomy. The second group (8 p.) included 2 patients (4,2%), which had intestinal resection + intestinal anastomosis and 6 patients (12,5%) which had right hemicolectomy + ileotransversos-tomy. The third (24 p.) group included 12 patients (25,0%) had total proctocolectomy + terminal ileostomy and 12 (25.0%) patients had subtotal proc-tocolectomy + terminal ileostomy in first step and ileosigmaanastomosis in second step.

Analysis

In postoperative 6 months in first group11 patients (78,6%) of 14 had no complications. 1 pa-tient(9,1%) had malign and died 4 month after operation during chemotherapy because of continuous intoxication, liver failure andheart failure. The other 2(18,2%) had recurrence and intestinal stricture in 3 - 5 months of operation and operated late. 1 (9,1%) of patients which had ileostomy late

References

1. Bacterial Populations Colonizing the Rectal Mucosa in Patients with Ulcerative Colitis // Clinical Infectious Diseases. - 2004-06-15. - Т. 38, вып. 12. - 11КБ (716 слов) - 12:18, 6 декабря 2017

2. Bifidobacteriumanimalis subsp. lactis BB-12animalis subsp. lactis BB-12 for maintenance of remission in ulcerative colitis // J Crohns Colitis.. - 2011. - Т. 5(2). - С. 115-21. - PMID 21453880. Pitkala28 КБ (1681 слово) - 18:28, 9 января 2018

3. Baumgart DC, Sandborn WJ; Sandborn (2012). "Crohn's diseases". The Lancet. 380(9853): 1590605.

4. Ford, AC; Moayyedi, P; Hanauer, SB (5 February, 2013). "Ulcerative Colitis". BMJ (Clinical research ed.). 346: f432.

had total proctocolectomy + reconstruction of the reservoir from the intestinal loop and the other 1 (9,1%) died 6 days after the operation. The reasons were intoxication, liver failure and heart failure. In second group 8 patients had recurrence and took pharmacotherapy. 2 (25,0%) patients died.Other 6 (75,0%) needed surgical treatment. In third group 10 patients (41,67%) of 24 with proctocolectomy + terminal ileostomy and other 10 patients (41,67%) with two steppedoperations had recurrence, 4 patients (16,67%)in this group died.

Results

Reconstructive - restorational operations (total proctocolectomy + reconstruction of the reservoir from the intestinal loop) have permitted to improve objective estimation of the disease severity, to reduce the complications occurrence, to optimize the results of surgical treatment and to reduce the disease recurrence rate, postoperative complications and postoperative lethality. The viability of patients after this type of operations is higher than in other groups.

Conclusions

Patients in first group had 14,3% lethality and 21,4% postoperative complications, patients in second group had 25% lethality and 75% postoperative complications, patients in third group had lethality 16,7% and 41,7% postoperative complications.

5. GBD 2015 Disease and injury incidence and Prevalence, Collaborators 08 October 2016, J.: Lancet. 388 (10053): 1545-1602.

6. Raymond K Cross (September 2012). «Vedoli-zumab for the treatment of ulcerative colitis and Crohn's disease». Immunotherapy 4 (9): 883-898. ENTYVIO- vedolizumab4^ (112 слов) - 10:54, 29 мая 2018

7. Targeting leukocyte migration and adhesion in Crohn's disease and ulcerative colitis // Inflammo-pharmacology. - 2012. - Т. 20, вып. 1. - С. 1-18. - D0I:1011 КБ (748 слов) - 08:54, 14 января 2018

8. "Ulcerative Colitis". NIDDK. September, 2014. Archived from the original on 28 July, 2016.Retrieved 3 August, 2016.