溃疡性结肠炎患者手术并发症病例报告

P. Turkin, A. A. Slesareva, V. A. Talanova, I. A. Burchakov, O. A. Stetsiuk, A. K. Dolgiev, P. Y. Golosnitskiy, E. P. Podoltseva, I. B. Dolgikh
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摘要

在发达国家,溃疡性结肠炎在年轻人群中的发病率迅速上升,这迫使医学界不仅要关注这种疾病的早期诊断和治疗问题,还要预防可能导致残疾的并发症的发生。本文回顾了一例长期活动性溃疡性结肠炎患者出现手术并发症的临床病例,该患者同时患有自身免疫性肝炎和原发性硬化性胆管炎长达 20 年之久。长期的活动性病程、结肠的完全损伤、原发性硬化性胆管炎以及患者对治疗的依从性较低,都是升结肠腺癌发生的危险因素,需要进行根治性手术治疗。粘连性疾病和多发性腹腔脓肿的形成可以说是长期并发症,这导致了反复使用侵入性治疗方法。在接下来的几个月里,患者又出现了两次局部化脓性并发症,由于抗生素治疗无效,需要进行手术治疗。由于长期使用免疫抑制剂,所有化脓性并发症都伴有进行性白细胞减少症。我们认为,对于长期服用细胞抑制剂的溃疡性结肠炎患者,应特别注意监测和纠正白细胞减少症,并预防化脓性并发症的发生。
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A case report of surgical complications in a patient with ulcerative colitis
Rapidly rising prevalence of ulcerative colitis in developed countries among young population compels the medical community to pay attention not only to the problems of early diagnosis and therapy of this disease, but also to preventing the development of complications, that may lead to disability. This article reviews a clinical case of the development of surgical complications in a patient with a long-term active course of ulcerative colitis, who has been also suffering from autoimmune hepatitis and primary sclerosing cholangitis for 20 years. The prolonged active course of the disease and total damage to the colon, association with primary sclerosing cholangitis, as well as the patient’s low adherence to therapy were risk factors for the development of adenocarcinoma of the ascending colon, which required radical surgical treatment. The formation of adhesive disease and multiple abdominal abscesses can be noted as long-term complications, which led to the repeated use of invasive methods of treatment. Over the next few months, the patient experienced 2 more episodes of local purulent complications that required surgical treatment due to the ineffectiveness of antibiotic therapy. All episodes of purulent complications were accompanied by progressive leukopenia due to prolonged use of immunosuppressive drugs. In our opinion, in patients with ulcerative colitis who take cytostatic agents for a long time, special attention should be paid to monitoring and correcting leukopenia, as well as preventing the development of purulent complications.
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