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Enteral nutrition combined with glutamine promotes recovery after ileal pouch-anal anastomosis in rats 被引量:10
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作者 Yan-Yan Xu An-Qi He +3 位作者 Gang Liu Kai-Yu Li Jian Liu Tong Liu 《World Journal of Gastroenterology》 SCIE CAS 2018年第5期583-592,共10页
AIM To assess the effect of enteral nutrition(EN) supplemented with glutamine on recovery after ileal pouch-anal anastomosis(IPAA) in rats, to provide an experimental basis for nutritional support in patients with ulc... AIM To assess the effect of enteral nutrition(EN) supplemented with glutamine on recovery after ileal pouch-anal anastomosis(IPAA) in rats, to provide an experimental basis for nutritional support in patients with ulcerative colitis(UC) after IPAA. METHODS Male Sprague-Dawley(SD) rats were randomly divided into three groups(n = 8) after IPAA operation using a microsurgical technique. From the third postoperative day, rats in the control group, EN group, and immune nutrition(IN) group were fed standard rat chow, short peptide EN, and short peptide EN combined with glutamine ad libitum, respectively. The rats' general condition was observed throughout the study. Serum levels of total protein(TP), albumin(ALB), prealbumin(PA), and transferrin(TF) were detected on the 30 th postoperative day, using an automatic biochemical analyzer. The ileal pouch mucosa was stained with hematoxylin and eosin(HE), and occludin protein levels were detected by immunohistochemistry.RESULTS The body weight of rats in the EN group(359.20 ± 10.06 g) was significantly higher than that in the control group(344.00 ± 9.66 g)(P < 0.05) and lower than that in the IN group(373.60 ± 9.86 g)(P < 0.05) on the 30 th postoperative day. The levels of serum TP, ALB, PA, and TF in the EN group were significantly higher than those in the control group(P < 0.01 for all) and lower than those in the IN group(P < 0.05 for all). Histopathological score(EN: 0.80 ± 0.37; IN: 0.60 ± 0.40; control group: 2.29 ± 0.18) and expression level of occludin protein(EN: 0.182 ± 0.054; IN: 0.188 ± 0.048; control group: 0.127 ± 0.032) were significantly lower in the control group compared with the EN and IN groups(P < 0.05 for all), but there were no significant differences between the latter two groups(P > 0.05 for all). CONCLUSION EN combined with glutamine may effectively improve nutritional status after IPAA. Our results suggest a benefit of glutamine supplementation in EN for UC patients undergoing IPAA, although human studies are required to confirm this find 展开更多
关键词 ENTERAL nutrition GLUTAMINE ILEAL pouchanal ANASTOMOSIS NUTRITIONAL status RECOVERY
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Recent trends in the surgical management of inflammatory bowel disease 被引量:10
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作者 Robert E Roses John L Rombeau 《World Journal of Gastroenterology》 SCIE CAS CSCD 2008年第3期408-412,共5页
Surgery is required in the vast majority of patients with Crohn’s disease (CD) and in approximately one-third of patients with ulcerative colitis (UC). Similar to medical treatments for IBD, significant advances have... Surgery is required in the vast majority of patients with Crohn’s disease (CD) and in approximately one-third of patients with ulcerative colitis (UC). Similar to medical treatments for IBD, significant advances have occurred in surgery. Advances in CD include an emphasis upon conservatism as exemplified by more limited resections, strictureplasties, and laparoscopic resections. The use of probiotics in selected patients has improved the outcome in patients with pouchitis following restorative proctocolectomy for UC. It is anticipated that ongoing discoveries in the molecular basis of IBD will in turn identify those patients who will best respond to surgery. 展开更多
关键词 Crohn's disease Ulcerative colitis Ileal pouchanal anastomosis Laparoscopic colectomy
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Update on medical and surgical options for patients with acute severe ulcerative colitis: what is new? 被引量:4
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作者 Rachel E Andrew Evangelos Messaris 《World Journal of Gastrointestinal Surgery》 SCIE CAS 2016年第9期598-605,共8页
Acute severe ulcerative colitis(UC) is a highly morbid con dition that requires both medical and surgical managementhrough the collaboration of gastroenterologists and colorectal surgeons. First line treatment for pat... Acute severe ulcerative colitis(UC) is a highly morbid con dition that requires both medical and surgical managementhrough the collaboration of gastroenterologists and colorectal surgeons. First line treatment for patients presenting with acute severe UC consists of intravenous steroids, but those who do not respond require escalation of therapy or emergent colectomy. The mortality of emergent colectomy has declined significantly in recent decades, but due to the morbidity of this procedure, second line agents such as cyclosporine and infliximab have been used as salvage therapy in an attempt to avoid emergent surgery. Unfortunately, protracted medical therapy has led to patients presenting for surgery in a poorer state of health leading to poorer post-operative outcomes. In this era of multiple medical modalities available in the treatment of acute severe UC, physicians must consider the advantages and disadvantages of prolonged medical therapy in an attempt to avoid surgery. Colectomy remains a mainstay in the treatment of severe ulcerative colitis not responsive to corticosteroids and rescue therapy, and timely referral for surgery allows for improved post-operative outcomes with lower risk of sepsis and improved patient survival. Options for reconstructive surgery include three-stage ileal pouchanal anastomosis or a modified two-stage procedure that can be performed either open or laparoscopically. The numerous avenues of medical and surgical therapy have allowed for great advances in the treatment of patients with UC. In this era of options, it is important to maintain a global view, utilize biologic therapy when indicated, and then maintain an appropriate threshold for surgery. The purpose of this review is to summarize the growing number of medical and surgical options available in the treatment of acute, severe UC. 展开更多
关键词 Acute severe ULCERATIVE colitis COLECTOMY CORTICOSTEROIDS INFLIXIMAB CYCLOSPORINE ILEAL pouchanal anastomosis
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家族性腺瘤性息肉病的外科治疗进展 被引量:4
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作者 李凯钰 刘刚 《世界华人消化杂志》 CAS 2019年第4期252-259,共8页
家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)是一种癌变倾向较高的常染色体显性遗传病.预防性外科干预的时机和手术方式的选择在以腺瘤的数量、大小和严重程度为主要决定因素的同时,应结合多方面情况综合考虑,在有效预防... 家族性腺瘤性息肉病(familial adenomatous polyposis,FAP)是一种癌变倾向较高的常染色体显性遗传病.预防性外科干预的时机和手术方式的选择在以腺瘤的数量、大小和严重程度为主要决定因素的同时,应结合多方面情况综合考虑,在有效预防癌变的同时使患者易于接受.全结直肠切除、回肠贮袋肛管吻合术(ileal pouch anal anastomosis, IPAA)已经成为FAP患者的首选治疗方案.IPAA能够最大限度减少直肠黏膜残留、降低腺瘤复发癌变风险,而腹腔镜IPAA具有美观、恢复快、黏连少、妊娠率高等明显优势. FAP患者应由在专业的医疗中心工作的经验丰富的外科医生进行管理,以便在最佳的时机得到最合理的治疗,达到长期有效的治疗结果. 展开更多
关键词 家族性腺瘤性息肉病 回肠贮袋肛管吻合术 回肠直肠吻合术 外科治疗 腹腔镜技术
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结肠J型贮袋在高龄低位直肠癌患者保肛手术后控便功能中的作用 被引量:4
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作者 鲁兵 傅传刚 +4 位作者 刘连杰 刘玉祥 陈勇 周坤 王振宜 《中华老年多器官疾病杂志》 2008年第3期182-185,189,共5页
目的评价采用J型贮袋在高龄患者保肛手术后改善排便机能中的价值。方法选取2002年2月至2003年8月诊治的39例高龄(≥75岁)低位直肠癌患者。按手术方式分成两组,传统的结肠断端与直肠肛管直接端端吻合组(直吻组),结肠J型贮袋与直肠肛管行... 目的评价采用J型贮袋在高龄患者保肛手术后改善排便机能中的价值。方法选取2002年2月至2003年8月诊治的39例高龄(≥75岁)低位直肠癌患者。按手术方式分成两组,传统的结肠断端与直肠肛管直接端端吻合组(直吻组),结肠J型贮袋与直肠肛管行端侧吻合组(贮袋组),对保肛手术后控便情况进行调查研究。结果术后排便次数正常的时间:贮袋组优于直吻组(P<0.01)。术后3个月、半年,贮袋组平均排便次数明显少于直吻组(P<0.05);延缓排便控制能力、失禁综合评分、区分排便排气能力等指标均优于直吻组(P<0.05);但术后1年及1年半,两组控便能力差异无显著性(P>0.05)。贮袋组直肠测压值优于直吻组。术后控便情况满意率贮袋组高于直吻组。采用贮袋吻合术后便秘的发生率高于直接吻合术(P<0.01)。结论(1)高龄不是结肠贮袋直肠肛管吻合术的禁忌证;(2)采用结肠贮袋直肠肛管吻合术能够明显改善高龄患者术后1年内控便功能。 展开更多
关键词 低位直肠癌 保肛手术 结肠J型贮袋 年龄因素
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RP-IPAA治疗溃疡性结肠炎相关进展
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作者 张玉新 杨文奇 《中国社区医师》 2015年第30期14-14,19,共2页
溃疡性结肠炎是一种慢性、难治性疾病,近年发病率呈上升趋势。难治性远端溃疡性结肠炎对多数药物敏感性较低,无法达到很好的治疗效果。适时、正确的手术治疗方式不仅可以治愈溃疡性结肠炎,而且可以明显减少术后并发症。全结直肠切除-回... 溃疡性结肠炎是一种慢性、难治性疾病,近年发病率呈上升趋势。难治性远端溃疡性结肠炎对多数药物敏感性较低,无法达到很好的治疗效果。适时、正确的手术治疗方式不仅可以治愈溃疡性结肠炎,而且可以明显减少术后并发症。全结直肠切除-回肠储袋肛管吻合术(RP-IPAA)安全,可降低手术并发症发生率,为溃疡性结肠炎患者,尤其是难治性远端溃疡性结肠炎患者提供了一个良好的选择治疗方式。 展开更多
关键词 溃疡性结肠炎 药物 直肠切除-回肠贮袋肛管吻合
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