Kirurško liječenje ulceroznog kolitisa

master's thesis

• Title (english): Ulcerative colitis - surgical treatment
• Author: Duje Braovac
• Mentor: Žarko Rašić (mentor)
• Committee member: Leonardo Patrlj (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Žarko Rašić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2015-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Ulcerozni kolitis (UK) je kronična upalna bolest sluznice debelog crijeva, obilježena izmjenama faza relapsa i remisije. Simptomi i težina bolesti znatno variraju u različitih bolesnika s ulceroznim kolitisom. UK se može prezentirati kao blaga bolest, ali i kao akutni fulminantni kolitis. To je životno ugrožavajuće stanje koje može zahtijevati i operacijsko liječenje. Najčešći simptomi UK su: rektalno krvarenje, proljevi, grčevi u abdomenu, urgencija i tenezmi. Prema podacima epidemiološke studije za Primorsko-goransku županiju za razdoblje od 2000. do 2004. incidencija ulceroznog kolitisa je 4,3/100.000/godinu. Medikamentno liječenje UK nije kurativno, već je usmjereno na kontroliranje upalnog procesa crijeva i ublažavanje simptoma. Operacijsko liječenje je važna terapijska opcija u ulceroznom kolitisu. Naime, UK je bolest koja je ograničena na kolon i rektum pa se ulcerozni kolitis proktokolektomijom, za razliku od Crohnove bolesti, može kirurški izliječiti. Odstranjenje kolona i rektuma, osim što dovodi do izliječenja, u potpunosti uklanja mogućnost za razvoj maligne bolesti. Indikacije za operacijsko liječenje UK su: na terapiju rezistentni fulminantni kolitis, toksični megakolon, masivno krvarenje, perforacija, karcinom i slab odgovor na medikamentnu terapiju. Usprkos stalnom napretku medikamentnog liječenja, još uvijek mnogi bolesnici s UK na kraju ipak trebaju i operacijsko liječenje. U ovom diplomskom radu govori se o UK općenito, a posebna pozornost je posvećena kirurškom liječenju. Postoji pet glavnih kirurških opcija za liječenje UK. To su: subtotalna kolektomija s ileostomijom, kolektomija s ileorektalnom anastomozom, totalna proktokolektomija s ileostomijom, proktokolektomija s kontinentnom ileostomijom (Kock pouch) i proktokolektomija s ilealnim spremnikom („J“ pouch) i analnom anastomozom. Zasebno se analizira svaka od ovih kirurških opcija sa svojim prednostima i nedostatcima. Raspravlja se i o indikacijama i kontraindikacijama različitih kirurških zahvata, kao i o ranim i kasnim komplikacijama te ishodu.

Abstract (english)

Ulcerative colitis (UC) is a relapsing and remitting inflammatory disorder of the colonic mucosa. The severity of the disease can vary greatly. UC can take the form of a mild disease, but it can also present as an acute fulminant and potentially fatal disorder requiring urgent surgery. The most common symptoms of ulcerative colitis are: bloody diarrhoea, abdominal pain, urgency and tenesmus. The incidence of ulcerative colitis in Primorje-Gorski Kotar County is 4,3/100.000/year. In ulcerative colitis, medical therapy, which is not curative, is directed at controlling symptoms and reducing the underlying inflammatory process. Surgery is a very good treatment option in UC, mainly because the disease is confined to the colon and rectum, and therefore proctocolectomy is curative. Removal of the colon and rectum not only cures the disease but also eliminates the possibility of developing a malignancy. Indications for surgery are: resistant fulminant colitis, toxic megacolon, massive haemorrhage, perforation, cancer and failure to respond to medical therapy. Despite important advances in medical therapy, which reduced the abovementioned catastrophic complications, many patients with UC will eventually require a surgical resection. Currently, there are several options for patients requiring surgery for ulcerative colitis. Subtotal colectomy and ileostomy is often performed in patients requiring surgery urgently or emergently. The more definitive options include colectomy and ileorectal anastomosis (IRA), total proctocolectomy and end ileostomy, proctocolectomy with continent ileostomy (Kock pouch), and restorative proctocolectomy with ileoanal reservoir/ileal pouch–anal anastamosis (IPAA). The purpose of my thesis is to explore these surgical options for UC all with their own advantages and disadvantages. I discuss indications for each of the surgical options, elective and urgent operative management, early and late complications of surgery, and outcome.

• Keywords: ulcerozni kolitis; UK; upalna bolest crijeva; operacijsko liječenje; proktokolektomija
• Keywords (english): ulcerative colitis; UC; inflammatory disorder; surgery; surgical resection; proctocolectomy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:832239
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-08-11 10:32:33