Viszeralmedizin最新文献_第3页

Inflammatory Bowel Diseases: Current Medical and Surgical Therapy 炎症性肠病:当前的内科和外科治疗

Viszeralmedizin

Pub Date : 2015-08-01 DOI: 10.1159/000438767

G. Lamprecht, R. Atreya, M. Kreis, B. Siegmund, A. Stallmach

a Division of Gastroenterology and Endocrinology, University Medical Center Rostock, Rostock, Germany, b Medical Clinic 1, Friedrich-Alexander University Erlangen-Nurnberg, Erlangen, Germany, c Department of General, Visceraland Vascular Surgery, Charite – University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany, d Medical Department (Gastroenterology, Infectious Diseases, Rheumatology), Charite – University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany, e Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany

a德国罗斯托克大学医学中心胃肠病学和内分泌科，b德国埃尔兰根-纽伦堡弗里德里希-亚历山大大学医学1诊所，德国埃尔兰根，c德国柏林本杰明富兰克林校区柏林查理特大学医学院综合脏器血管外科，d德国柏林本杰明富兰克林校区柏林查理特大学医学院内科(胃肠病学，传染病，风湿病学)，德国柏林本杰明富兰克林校区，德国柏林e德国耶拿耶拿大学医院内科四科(消化内科、肝脏内科和传染病科)

引用次数: 0

Surgical Principles in the Treatment of Ulcerative Colitis 溃疡性结肠炎的外科治疗原则

Viszeralmedizin

Pub Date : 2015-08-01 DOI: 10.1159/000438894

Florian Kühn, E. Klar

Background: The primary treatment of ulcerative colitis (UC) is conservative; surgical intervention is carried out in the case of therapy-refractory situation, imminent or malignant transformation, or complications. Surgery for UC should be indicated by interdisciplinary means. Despite the development of drug therapy - in particular the introduction of biologics -, a surgical intervention becomes necessary in a relevant proportion of patients with UC throughout lifetime. Methods: A selective literature search was conducted, taking into account the current studies, reviews, meta-analyses, and guidelines. PubMed served as a database. The present work gives an overview of the surgical options, outcome as well as peri- and postoperative management for patients with UC. Results: Approximately 20% of patients with UC will require surgery during the course of their disease. The rate of colectomy after a disease duration of 10 years is at approximately 16%. Unlike Crohn's disease, UC is principally surgically curable since it is naturally limited to the colon and rectum. Restorative proctocolectomy with an ileal pouch-anal anastomosis represents the surgical treatment of choice. Large studies show a postoperative complication rate of around 30% and a low mortality of 0.1% for this procedure. Chronic pouchitis is one of the main factors limiting the surgical success of curing UC. Despite a high postoperative complication rate, there is a long-term pouch success rate of >90% after 10 and 20 years of follow-up. Conclusion: A close cooperation between the various disciplines in the pre- and postoperative setting is essential for an optimal outcome of patients with UC. Despite a 30% rate of early postoperative complications, normal quality of life can ultimately be reached in more than 90% of patients in experienced centers.

背景:溃疡性结肠炎(UC)的主要治疗方法是保守治疗;手术干预的情况下，治疗难治性的情况下，即将或恶性转化，或并发症。UC的手术应采用跨学科的方法。尽管药物治疗的发展，特别是生物制剂的引入，但在一定比例的UC患者一生中，手术干预是必要的。方法:进行选择性文献检索，考虑当前研究、综述、荟萃分析和指南。PubMed是一个数据库。目前的工作概述了UC患者的手术选择，结果以及围手术期和术后管理。结果:大约20%的UC患者在病程中需要手术。疾病持续10年后结肠切除术的发生率约为16%。与克罗恩病不同，UC主要通过手术治愈，因为它自然局限于结肠和直肠。恢复性直结肠切除术与回肠袋肛管吻合是手术治疗的选择。大型研究表明，该手术的术后并发症发生率约为30%，死亡率低至0.1%。慢性袋炎是限制UC手术治疗成功的主要因素之一。尽管术后并发症发生率高，但经过10年和20年的随访，长期眼袋成功率为90%。结论:在术前和术后各学科之间的密切合作对于UC患者的最佳预后至关重要。尽管有30%的早期术后并发症，但在经验丰富的中心，90%以上的患者最终可以达到正常的生活质量。

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引用次数: 28

Endoscopic Therapy in Inflammatory Bowel Diseases 炎症性肠病的内镜治疗

Viszeralmedizin

Pub Date : 2015-08-01 DOI: 10.1159/000435851

H. Neumann, M. Neurath, R. Atreya

Background: Endoscopy is an essential diagnostic and therapeutic modality in the clinical care of inflammatory bowel disease (IBD) patients. Endoscopic therapy can be used for treatment of disease-related strictures, surveillance and resection of intraepithelial neoplasia, and treatment of fistulas or disease-related complications, and is currently being evaluated regarding its capacity in in vivo molecular imaging procedures. Methods: A literature search using Medline and Science Citation Index was performed in March 2015. All studies on endoscopic therapy in IBD published from 1980 to 2015 (March) were reviewed. Potential studies were initially screened by title and abstract. The terms ‘endoscopy IBD', ‘endoscopy therapy IBD', ‘dilatation IBD', ‘strictureplasty Crohn's disease', ‘endoscopy therapy fistula', ‘endoscopy toxic megacolon', ‘endoscopy dysplasia IBD', ‘endoscopy complications IBD', and ‘molecular imaging IBD' were used in the search. A total of 115 articles were studied to construct this review. Results: Dilatation is most useful in short anastomotic strictures, but can be also undertaken in colonic strictures. Strictures in ulcerative colitis are always suspicious for neoplasia and should be evaluated carefully. Lesions with intraepithelial neoplasia can be resected when complete removal can be assured. The finding of carcinoma or high-grade dysplasia in a random biopsy is an indication for colectomy. If intraepithelial neoplasia is present in random biopsy specimens, colectomy should similarly be recommended. Endoscopic therapy of Crohn's fistulas is a possible emerging technology. In vivo molecular imaging is currently being studied in IBD patients and offers promising therapeutic opportunities. Conclusion: Therapeutic endoscopy is indispensable in the management of IBD. It has to be carefully evaluated against alternative surgical options but often offers an effective therapeutic approach.

背景:内窥镜检查是炎症性肠病(IBD)患者临床护理中必不可少的诊断和治疗方式。内窥镜治疗可用于治疗与疾病相关的狭窄，监测和切除上皮内瘤变，治疗瘘管或与疾病相关的并发症，目前正在评估其在体内分子成像程序中的能力。方法:于2015年3月使用Medline和Science Citation Index进行文献检索。回顾1980年至2015年3月发表的所有IBD内镜治疗研究。初步通过题目和摘要筛选潜在的研究。术语“内窥镜IBD”、“内窥镜治疗IBD”、“扩张性IBD”、“狭窄性克罗恩病”、“内窥镜治疗瘘管”、“内窥镜毒性巨结肠”、“内窥镜发育不良IBD”、“内窥镜并发症IBD”和“分子成像IBD”被用于搜索。本综述共纳入115篇文献。结果:扩张术适用于吻合口狭窄，但也适用于结肠狭窄。溃疡性结肠炎的狭窄常被怀疑为肿瘤，应仔细评估。当能保证完全切除时，可以切除上皮内瘤变病变。在随机活检中发现癌或高度不典型增生是结肠切除术的指征。如果随机活检标本中存在上皮内瘤变，则同样建议结肠切除术。内窥镜治疗克罗恩氏瘘管是一种可能的新兴技术。体内分子成像目前正在对IBD患者进行研究，并提供了有希望的治疗机会。结论:治疗性内镜在IBD治疗中不可或缺。它必须仔细评估替代手术选择，但通常提供有效的治疗方法。

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引用次数: 8

Indications and Specific Surgical Techniques in Crohn's Disease 克罗恩病的适应症和特殊手术技术

Viszeralmedizin

Pub Date : 2015-08-01 DOI: 10.1159/000438955

C. Seifarth, M. Kreis, J. Gröne

Background: Crohn's disease (CD) as one of the major entities of chronic inflammatory bowel diseases can affect all segments of the gastrointestinal tract but occurs most often in the small bowel, the terminal ileum, the colon, and the rectum. Typical symptoms include tiredness, lower abdominal pain, fever, and diarrhea, which are initially treated by conservative measures. Most patients will eventually develop complications such as fistulas, abscesses, or strictures. Surgery is often unavoidable in these cases. Methods: This review considers studies on the treatment of CD, published from 1979 up to now. The literature regarding the course, complications, and surgical therapy of CD was reviewed. Searches were performed in PubMed, using the following key words: CD, surgery, immunosuppression, guidelines, malnutrition as well as appropriate sub-items. In most cases the literature is limited to detailed information on specific therapeutic or diagnostic topics. Moreover, many studies are designed retrospectively and with a small number of patients. Additionally, our long-standing experience with patients suffering from CD is taken into consideration in this review. Results: There is a wide variety of indications for surgery in CD which includes complications like strictures, fistulas and abscess formation, neoplasia, or refractoriness to medical therapy. The risk of developing complications is about 33% after 5 years, and 50% after 20 years. Furthermore, one-third of CD patients need surgical therapy within the ﬁrst 5 years of diagnosis. The treatment requires close cooperation between gastroenterologists and surgeons. When indicated, surgery should be performed in a ‘conservative' fashion, i.e. as limited as possible, in order to achieve the required result and to avoid small bowel syndrome. Conclusion: This article provides a complete overview of indications and specific surgical treatment in patients with CD. Surgery is typically indicated when complications of CD occur. An interdisciplinary collaboration is necessary in order to ensure optimal indications and timing of surgery. This is of paramount importance to achieve the ultimate goal, i.e. a good quality of life of the patients.

背景:克罗恩病(CD)作为慢性炎症性肠病的主要实体之一，可影响胃肠道的所有部分，但最常见于小肠、回肠末端、结肠和直肠。典型症状包括疲劳、下腹痛、发热和腹泻，最初采用保守措施治疗。大多数患者最终会出现并发症，如瘘管、脓肿或狭窄。在这种情况下，手术通常是不可避免的。方法:对1979年至今发表的有关CD治疗的研究进行综述。本文回顾了有关乳糜泻病程、并发症及手术治疗的文献。在PubMed中进行检索，使用以下关键词:CD，手术，免疫抑制，指南，营养不良以及适当的分项。在大多数情况下，文献仅限于具体的治疗或诊断主题的详细信息。此外，许多研究是回顾性设计的，患者数量很少。此外，本综述还考虑了我们长期治疗乳糜泻患者的经验。结果:CD的手术指征多种多样，包括并发症，如狭窄、瘘管和脓肿形成、瘤变或药物治疗难治性。5年后发生并发症的风险约为33%，20年后为50%。此外，三分之一的乳糜泻患者在确诊后的前5年内需要手术治疗。治疗需要胃肠病学家和外科医生的密切合作。当有指征时，手术应以“保守”方式进行，即尽可能限制，以达到所需的结果并避免小肠综合征。结论:本文提供了CD患者的适应症和特定手术治疗的完整概述。当出现CD并发症时，通常需要手术。为了确保最佳的适应证和手术时机，跨学科合作是必要的。这对于实现最终目标，即患者的良好生活质量至关重要。

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引用次数: 20

Medical Therapy of Active Ulcerative Colitis 活动性溃疡性结肠炎的药物治疗

Viszeralmedizin

Pub Date : 2015-08-01 DOI: 10.1159/000436959

M. Bürger, C. Schmidt, N. Teich, A. Stallmach

Background: Medical therapy of mild and moderate ulcerative colitis (UC) of any extent is evidence-based and standardized by national and international guidelines. However, patients with steroid-refractory UC still represent a challenge. Methods: A literature search using PubMed (search terms: ulcerative colitis, therapy, new, 1-2008-2015) resulted in 821 publications. For the current article, 88 citations were extracted including 36 randomized controlled studies, 18 reviews, and 8 meta-analyses. Results: In steroid-refractory UC, early intensive therapy using anti-tumor necrosis factor (TNF) antibodies or the calcineurin inhibitors cyclosporine and tacrolimus is indicated in any case to prevent progression to a toxic megacolon and/or to avoid proctocolectomy. In patients with chronic disease activity, treatment with anti-TNF antibodies has a higher level of evidence than azathioprine therapy and should therefore be preferred. However, there is a subgroup of UC patients who may achieve prolonged steroid-free remission on azathioprine monotherapy. The importance of vedolizumab, a newly registered inhibiting antibody against integrin, has not yet been fully clarified since direct comparison studies are lacking, in particular in relation to anti-TNF antibodies. Conclusion: There is a great need for additional innovative therapies, especially in cases of primary non-response or secondary loss of response to anti-TNF antibodies. New small molecules (Janus kinase inhibitors) are promising with an acceptable safety profile and efficacy in UC. Further, strategies that target the intestinal microbiome are currently considered for patients with active or relapsing UC, and may in the future open up new therapeutic options.

背景:任何程度的轻中度溃疡性结肠炎(UC)的药物治疗都是循证的，并被国家和国际指南标准化。然而，类固醇难治性UC患者仍然是一个挑战。方法:使用PubMed进行文献检索(检索词:溃疡性结肠炎，治疗，new, 1-2008-2015)，共获得821篇文献。在这篇文章中，我们提取了88条引用，包括36项随机对照研究、18篇综述和8项荟萃分析。结果:在类固醇难治性UC中，在任何情况下，使用抗肿瘤坏死因子(TNF)抗体或钙调磷酸酶抑制剂环孢素和他克莫司进行早期强化治疗，以防止发展为毒性巨结肠和/或避免直结肠切除术。在慢性疾病活动性的患者中，抗tnf抗体治疗比硫唑嘌呤治疗有更高的证据，因此应优先考虑。然而，有一亚组UC患者可以通过硫唑嘌呤单药治疗获得长期无类固醇缓解。vedolizumab是一种新注册的抗整合素的抑制抗体，其重要性尚未完全阐明，因为缺乏直接的比较研究，特别是与抗tnf抗体相关的研究。结论:迫切需要更多的创新疗法，特别是在抗tnf抗体原发性无反应或继发性丧失反应的情况下。新的小分子(Janus激酶抑制剂)在UC中具有可接受的安全性和有效性。此外，目前正在考虑针对活动性或复发性UC患者的肠道微生物组的策略，并可能在未来开辟新的治疗选择。

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引用次数: 11

Occult and Manifest Colorectal Carcinoma in Ulcerative Colitis: How Does It Influence Surgical Decision Making? 溃疡性结肠炎的隐蔽性和显性结直肠癌:如何影响手术决策?

Viszeralmedizin

Pub Date : 2015-07-31 DOI: 10.1159/000438811

J. Hardt, P. Kienle

Background: The incidence of colorectal cancer (CRC) among patients with ulcerative colitis (UC) is increased compared to the general population. The diagnosis of CRC potentially influences surgical decision making in patients with UC. Methods: This review considers clinical studies, systematic reviews, and guidelines on the surgical therapy of CRC in UC. We searched the bibliographic databases The Cochrane Library and Medline (applying MeSH terms such as ‘Colitis, Ulcerative/surgery', ‘Colorectal Neoplasms', and ‘Proctocolectomy, Restorative') with no restriction on language, date, or country. Search results as well as references of relevant publications were independently screened by both authors of this review. Results: The surgical gold standard for proven CRC in UC is oncological proctocolectomy, if possible preferably as a restorative procedure with formation of an ileal pouch-anal anastomosis. Mucosectomy and hand-sewn anastomosis is the preferred option for fashioning the anastomosis in these patients, especially in case of dysplasia or cancer in the rectum, although the available data is not conclusive. In highly selected cases of patients with histologically confirmed sporadic CRC without dysplasia in multiple random biopsies and without relevant inflammation, a conventional limited oncological resection is adequate. If UC patients with rectal cancer require radiotherapy, it should be performed in a neoadjuvant setting because of the high risk of radiation-induced pouch failure. Conclusion: Although restorative proctocolectomy is clearly the gold standard therapy for patients with CRC in UC, surgical decision making has to take into account the various settings and patient factors.

背景:溃疡性结肠炎(UC)患者中结直肠癌(CRC)的发病率比一般人群增加。结直肠癌的诊断可能影响UC患者的手术决策。方法:本文综述了UC中结直肠癌手术治疗的临床研究、系统综述和指南。我们检索了文献数据库Cochrane Library和Medline(使用MeSH术语，如“结肠炎，溃疡性/外科”、“结直肠肿瘤”和“直结肠切除术，恢复性”)，没有语言、日期或国家限制。检索结果和相关出版物的参考文献均由本综述的两位作者独立筛选。结果:UC中结直肠癌的手术金标准是肿瘤直结肠切除术，如果可能，最好作为回肠袋-肛门吻合术形成的恢复性手术。在这些患者中，特别是在直肠发育不良或癌症的情况下，尽管现有的数据尚无定论，但粘膜切除术和手缝吻合术是形成吻合口的首选方法。在多次随机活检组织学证实的散发性结直肠癌患者中，没有异常增生且没有相关炎症，常规的有限肿瘤切除术是足够的。如果UC患者合并直肠癌需要放射治疗，则应在新辅助环境下进行，因为放射引起的袋衰的风险很高。结论:虽然恢复性直结肠切除术显然是UC结直肠癌患者的金标准治疗，但手术决策必须考虑各种情况和患者因素。

{"title":"Occult and Manifest Colorectal Carcinoma in Ulcerative Colitis: How Does It Influence Surgical Decision Making?","authors":"J. Hardt, P. Kienle","doi":"10.1159/000438811","DOIUrl":"https://doi.org/10.1159/000438811","url":null,"abstract":"Background: The incidence of colorectal cancer (CRC) among patients with ulcerative colitis (UC) is increased compared to the general population. The diagnosis of CRC potentially influences surgical decision making in patients with UC. Methods: This review considers clinical studies, systematic reviews, and guidelines on the surgical therapy of CRC in UC. We searched the bibliographic databases The Cochrane Library and Medline (applying MeSH terms such as ‘Colitis, Ulcerative/surgery', ‘Colorectal Neoplasms', and ‘Proctocolectomy, Restorative') with no restriction on language, date, or country. Search results as well as references of relevant publications were independently screened by both authors of this review. Results: The surgical gold standard for proven CRC in UC is oncological proctocolectomy, if possible preferably as a restorative procedure with formation of an ileal pouch-anal anastomosis. Mucosectomy and hand-sewn anastomosis is the preferred option for fashioning the anastomosis in these patients, especially in case of dysplasia or cancer in the rectum, although the available data is not conclusive. In highly selected cases of patients with histologically confirmed sporadic CRC without dysplasia in multiple random biopsies and without relevant inflammation, a conventional limited oncological resection is adequate. If UC patients with rectal cancer require radiotherapy, it should be performed in a neoadjuvant setting because of the high risk of radiation-induced pouch failure. Conclusion: Although restorative proctocolectomy is clearly the gold standard therapy for patients with CRC in UC, surgical decision making has to take into account the various settings and patient factors.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"1 1","pages":"252 - 257"},"PeriodicalIF":0.0,"publicationDate":"2015-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000438811","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64897669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Medical Therapy of Perianal Crohn's Disease 肛周克罗恩病的医学治疗

Viszeralmedizin

Pub Date : 2015-07-29 DOI: 10.1159/000434664

T. Klag, M. Goetz, E. Stange, J. Wehkamp

Background: Development of perianal fistulas are a common feature of Crohn's disease (CD). Consequences are severe impairment of quality of life as well as potentially life-threatening complications like abscess formation or bacterial sepsis. Therefore, appropriate treatment is an important task in the management of CD. Methods: This review describes the epidemiology, pathogenesis, diagnosis, and conservative medical treatment of perianal CD with regard to the available literature. In February 2015, a PubMed search was performed with the following terms (combined and separate): ‘Crohn's disease management', ‘Crohn's disease complications', ‘perianal Crohn's disease', ‘fistulizing Crohn's disease', ‘perianal fistulas', ‘fistula healing', ‘fistula closure'. From the search results, 36 articles were chosen as core elements of this review. Results: Pelvic magnetic resonance imaging and rectal endosonography are established diagnostic approaches to evaluate perianal fistulas in conjunction with endoscopy. Antibiotics, thiopurines, and calcineurin inhibitors are useful agents in the management of perianal CD. The availability of anti-TNF-alpha therapies has substantially changed the prospects and goals of medical treatment, and fistula healing seems to be possible in a substantial proportion of patients. Conclusion: Antibiotics and several immunosuppressive drugs have improved the treatment of fistulizing CD and should be combined with surgical measures.

背景:肛门周围瘘管的发展是克罗恩病(CD)的共同特征。其后果是生活质量严重受损，以及可能危及生命的并发症，如脓肿形成或细菌性败血症。因此，适当的治疗是管理CD的重要任务。方法:本文综述了现有文献中肛周CD的流行病学、发病机制、诊断和保守治疗。2015年2月，在PubMed上搜索了以下术语(合并和单独):“克罗恩病管理”、“克罗恩病并发症”、“肛周克罗恩病”、“瘘管愈合”、“瘘管闭合”。从检索结果中选择36篇文章作为本综述的核心要素。结果:盆腔磁共振成像和直肠超声检查结合内镜检查是评估肛周瘘的可靠诊断方法。抗生素、硫嘌呤和钙调磷酸酶抑制剂是治疗肛周CD的有效药物。抗tnf - α疗法的可用性大大改变了医学治疗的前景和目标，并且在相当大比例的患者中，瘘管愈合似乎是可能的。结论:抗生素和多种免疫抑制药物改善了瘘管性乳糜泻的治疗效果，应与手术措施相结合。

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引用次数: 11

New Imaging Techniques in the Diagnosis of Inflammatory Bowel Diseases 诊断炎症性肠病的新影像技术

Viszeralmedizin

Pub Date : 2015-07-28 DOI: 10.1159/000435864

Yan Li, K. Hauenstein

Background: Cross-sectional imaging modalities are fundamental in the management of patients with inflammatory bowel disease (IBD) from the first diagnosis and throughout the entire course of the disease. Over the past few years, the use of magnetic resonance (MR) imaging (MRI) has considerably increased, and no other imaging modality has experienced as advanced a development as MRI. Methods: A comprehensive literature search (PubMed/Medline) using keywords such as ‘MR enterography', ‘imaging modalities', ‘IBD', and ‘Crohn's disease' was performed. 48 articles published between 1999 and 2015 were systematically reviewed. In this article, besides the current standard MRI techniques, we review novel and implementable for routine use MR techniques. The use of positron emission tomography/computed tomography (PET/CT) and hybrid imaging such as PET/MRI with enormous potential will also be briefly discussed. Results: New imaging techniques such as diffusion-weighted imaging, dynamic contrast-enhanced MR perfusion, and MR motility imaging yield advanced findings about changes in the microenvironment and alterations in motility of the affected bowel segment, and are proven to improve the diagnostic accuracy in assessing the scale, activity level, and severity of the IBD. Novel magnetization transfer imaging allows direct visualization of fibrosis in the bowel wall. Conclusion: Diffusion-weighted imaging can be easily implemented in standard MRI for routine use to further enhance the diagnostic accuracy in disease assessment. For validation of magnetization transfer imaging, larger studies are warranted.

背景:横断面成像模式是炎症性肠病(IBD)患者从首次诊断到整个病程的基本治疗方法。在过去的几年中，磁共振(MR)成像(MRI)的使用大大增加，没有其他成像方式经历了像MRI这样先进的发展。方法:使用“MR enterography”、“imaging mode”、“IBD”和“Crohn’s disease”等关键词进行全面的文献检索(PubMed/Medline)。系统回顾了1999年至2015年间发表的48篇文章。在本文中，除了目前的标准MRI技术，我们回顾了新的和可实现的常规使用MRI技术。本文还将简要讨论具有巨大潜力的正电子发射断层扫描/计算机断层扫描(PET/CT)和混合成像(如PET/MRI)的应用。结果:新的成像技术，如弥散加权成像、动态对比增强MR灌注和MR运动成像，对受影响肠段的微环境变化和运动改变有了先进的发现，并被证明在评估IBD的规模、活动水平和严重程度方面提高了诊断的准确性。新型磁化转移成像技术可直接观察肠壁纤维化。结论:弥散加权成像可方便地应用于标准MRI的常规应用，进一步提高疾病评估的诊断准确性。为了验证磁化转移成像，需要进行更大规模的研究。

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引用次数: 19

Medical Therapy of Fibrostenotic Crohn's Disease 纤维狭窄性克罗恩病的药物治疗

Viszeralmedizin

Pub Date : 2015-07-28 DOI: 10.1159/000435868

B. Siegmund

Introduction: The present review serves to provide a concise overview of the current knowledge on therapeutic strategies with regard to fibrostenotic lesions in Crohn's disease. Methods: A literature search was performed focusing on the last 5 years, and current concepts of pathophysiology, epidemiology, and treatment have been summarized. Results: Fibrostenotic lesions in Crohn's disease are currently considered to be a consequence of the chronic inflammatory nature of the disease. Hence, therapeutic strategies are limited to the concept that early treatment of the inflammatory lesions can prevent structural changes, and to various endoscopic and surgical approaches. Direct targeting of the fibrostenotic lesion itself has not been the focus until now. This review will provide an overview of the pathophysiology and epidemiology of fibrostenotic lesions including current therapeutic approaches. Since research with regard to other organ systems and fibrosis is far more advanced, current strategies from available studies in these areas will be discussed. The results and the potential impact for Crohn's disease will be considered. Conclusion: The vision of these approaches is to reverse structural changes and restore normal function.

简介:目前的回顾提供了关于克罗恩病纤维狭窄病变的治疗策略的当前知识的简要概述。方法:检索近5年的文献，总结当前病理生理学、流行病学和治疗的概念。结果:纤维狭窄病变在克罗恩病目前被认为是慢性炎症性疾病的后果。因此，治疗策略仅限于炎性病变的早期治疗可以防止结构改变的概念，以及各种内窥镜和手术方法。到目前为止，直接靶向纤维狭窄病变本身还不是研究的重点。本文综述了纤维狭窄病变的病理生理学和流行病学，包括目前的治疗方法。由于关于其他器官系统和纤维化的研究要先进得多，因此将讨论这些领域现有研究的当前策略。研究结果和对克罗恩病的潜在影响将被考虑在内。结论:这些入路的目的是逆转结构变化，恢复正常功能。

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引用次数: 4

Acute Cholecystitis. 急性胆囊炎。

Viszeralmedizin

Pub Date : 2015-06-01 Epub Date: 2015-06-08 DOI: 10.1159/000431275

Jochen Schuld, Matthias Glanemann

Background: The treatment of acute cholecystitis has been controversially discussed in the literature as there are no high-evidence-level data yet for determining the optimal point in time for surgical intervention. So far, the laparoscopic removal of the gallbladder within 72 h has been the most preferred approach in acute cholecystitis.

Methods: We conducted a systematic review by including randomized trials of early laparoscopic cholecystectomy for acute cholecystitis.

Results: Based on a few prospective studies and two meta-analyses, there was consent to prefer an early laparoscopic cholecystectomy for patients suffering from acute calculous cholecystitis while the term 'early' has not been consistently defined yet. So far, there is new level 1b evidence brought forth by the so-called 'ACDC' study which has convincingly shown in a prospective randomized setting that immediate laparoscopic cholecystectomy - within a time frame of 24 h after hospital admission - is the smartest approach in ASA I-III patients suffering from acute calculous cholecystitis compared to a more conservative approach with a delayed laparoscopic cholecystectomy after an initial antibiotic treatment in terms of morbidity, length of hospital stay, and overall treatment costs. Concerning critically ill patients suffering from acute calculous or acalculous cholecystitis, there is no consensus in treatment due to missing data in the literature.

Conclusion: Laparoscopic cholecystectomy for acute cholecystitis within 24 h after hospital admission is a safe procedure and should be the preferred treatment for ASA I-III patients. In critically ill patients, the intervention should be determined by a narrow interdisciplinary consent based on the patient's individual comorbidities.

背景:急性胆囊炎的治疗在文献中一直存在争议，因为尚无高证据水平的数据来确定手术干预的最佳时间点。到目前为止，72h内腹腔镜胆囊切除术是治疗急性胆囊炎的首选方法。方法:我们通过纳入早期腹腔镜胆囊切除术治疗急性胆囊炎的随机试验进行了系统综述。结果:基于几项前瞻性研究和两项荟萃分析，人们同意急性结石性胆囊炎患者首选早期腹腔镜胆囊切除术，但“早期”一词尚未得到一致的定义。到目前为止，所谓的“ACDC”研究提出了新的1b级证据，该研究在一项前瞻性随机设置中令人信服地显示，在入院后24小时内立即腹腔镜胆囊切除术是ASA I-III级急性结石性胆囊炎患者最明智的方法，与更保守的方法相比，在初始抗生素治疗后延迟腹腔镜胆囊切除术的发病率。住院时间和总治疗费用。对于急性结石性或无结石性胆囊炎的危重患者，由于文献资料缺失，治疗方法尚无共识。结论:急性胆囊炎入院后24小时内腹腔镜胆囊切除术是一种安全的手术，应作为ASA I-III级患者的首选治疗方法。对于危重患者，干预应根据患者个体合并症的狭窄的跨学科同意来确定。

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引用次数: 5