摘要
自从2005年批准用于治疗溃疡性结肠炎的抗TNF药物以来，人们一直担心这些药物对与袋手术有关的术后感染并发症的潜在有害作用。关于这个话题的数据是有争议的，并且大部分来自回顾性的，动力不足的队列研究，这些研究在很大程度上受到相关偏见的影响。已经发表了三项荟萃分析，结果相互矛盾。此外，在手术时英夫利昔单抗的血清水平与术后脓毒症并发症的发生之间的相关性尚待证实，仍是一个有待研究的问题。在难于治疗的溃疡性结肠炎（UC）患者中，将回肠袋肛门吻合术（IPAA）的构建作为第一步外科手术步骤似乎会增加败血症并发症的风险。来自美国的基于人群的数据显示，由于生物制剂的广泛使用以及将手术作为最终手段（逐步治疗）的趋势不断增加，难治性UC患者正在转向分期手术。在这种情况下，经典的3期手术（初次全结肠切除术后回肠袋和分流回肠造口术）以及改良的2期方法（初次全结肠切除术后不进行回肠造口术的回肠袋）都是有效的选择。回肠回肠造口术能否在手术第二阶段的小袋构造时预防小袋并发症仍是一个有争议的问题。新兴数据似乎声称与造口有关的小肠梗阻风险增加，但对预防吻合口漏没有有效作用。
关键词: 溃疡性结肠炎，袋装手术，生物制剂，抗TNF，术后感染，吻合术（IPAA）。
图形摘要
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