Binder S C, Miller H H, Deterling R A
Arch Surg. 1975 Mar;110(3):284-9. doi: 10.1001/archsurg.1975.01360090054012.
Eighty consecutive emergency and urgent colectomies for ulcerative colitis were performed. One-stage total proctocolectomy was performed in 37 patients, with a 9.1% mortality; ileostomy with subtotal colectomy was performed in 43, with a 7.0% mortality. The overall mortality was 7.5%. Postoperative morbidity after total proctocolectomy (mean postoperative hospitalization, 27.6 days; nonseptic complication rate, 29.4%; septic complication rate, 29.4%) was not substantially different from that after subtotal colectomy (postoperative hospitalization, 33.3 days; nonseptic complications, 45.0%; septic complications, 35.0%). Survivors of subtotal colectomy required abdominal-perineal resection of the colorectal remnant in 75.7% of patients, and no patient had successful subsequent ileorectal anastomosis. It is suggested that one-stage total proctocolectomy be adopted as the surgical procedure of choice in emergency or urgent operations for ulcerative colitis.
对80例连续性溃疡性结肠炎患者进行了急诊和紧急结肠切除术。37例患者接受了一期全直肠结肠切除术，死亡率为9.1%；43例患者接受了回肠造口术加结肠次全切除术，死亡率为7.0%。总体死亡率为7.5%。全直肠结肠切除术后的术后发病率（平均术后住院时间27.6天；非感染性并发症发生率29.4%；感染性并发症发生率29.4%）与结肠次全切除术后（术后住院时间33.3天；非感染性并发症45.0%；感染性并发症35.0%）相比，无显著差异。结肠次全切除术后的幸存者中，75.7%的患者需要对结直肠残余部分进行腹会阴切除术，且无一例患者随后成功进行回肠直肠吻合术。建议在溃疡性结肠炎的急诊或紧急手术中，采用一期全直肠结肠切除术作为首选手术方式。
