Kiran R P, O'Brien-Ermlich B, Achkar J P, Fazio V W, Delaney C P
Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Dis Colon Rectum. 2005 Jul;48(7):1397-403. doi: 10.1007/s10350-004-0944-x.
This study was designed to evaluate the presentation, management, and outcome of peristomal pyoderma gangrenosum at a specialist colorectal unit and develop a strategy for therapy.
Patients with peristomal pyoderma gangrenosum were identified from a prospectively accrued Institutional Review Board-approved stoma database. Data were collected regarding demographics, disease status, history of illness, time to healing, and treatments used from the database and by chart review.
Sixteen patients presented between 1997 and 2002 with peristomal ulceration consistent with a diagnosis of peristomal pyoderma gangrenosum. Diagnosis was predominantly clinically based on a classic presentation of painful, undermined peristomal ulceration. The underlying diagnosis was Crohn's disease in 11 patients, ulcerative colitis in 3, indeterminate colitis in 1, and posterior urethral valves in 1. At the time of development of peristomal pyoderma gangrenosum, the underlying disease was active in 69 percent of patients. Stoma care, ulcer debridement with unroofing of undermined edges, and intralesional corticosteroid injection was associated with a 40 percent complete response rate and further 40 percent partial response rate. Of five patients who received infliximab, four (80 percent) responded to therapy. Complete response after all forms of therapy, including stoma relocation in seven patients, was 87 percent.
Local wound management and enterostomal therapy are extremely important for patients with peristomal pyoderma gangrenosum. Infliximab may provide a useful option for those failing other forms of medical therapy. Relocation of the stoma is reserved for persistent ulceration failing other therapies, because peristomal pyoderma gangrenosum may recur at the new stoma site.
本研究旨在评估在一家专业结直肠病治疗中心，造口周围坏疽性脓皮病的临床表现、治疗方法及治疗效果，并制定相应的治疗策略。
从一个经机构审查委员会批准的前瞻性造口数据库中，筛选出患有造口周围坏疽性脓皮病的患者。通过数据库及病历审查，收集患者的人口统计学资料、疾病状态、病史、愈合时间及所采用的治疗方法等数据。
1997年至2002年间，共有16例患者出现符合造口周围坏疽性脓皮病诊断的造口周围溃疡。诊断主要基于典型的临床表现，即疼痛性、潜行性边缘的造口周围溃疡。基础疾病为克罗恩病的患者有11例，溃疡性结肠炎3例，未定型结肠炎1例，后尿道瓣膜症1例。在造口周围坏疽性脓皮病发病时，69%的患者基础疾病处于活动期。造口护理、对潜行边缘进行清创及病灶内注射皮质类固醇，完全缓解率为40%，部分缓解率为40%。在接受英夫利昔单抗治疗的5例患者中，4例（80%）对治疗有反应。包括7例患者进行造口重新定位在内，所有治疗方式后的完全缓解率为87%。结论：对于造口周围坏疽性脓皮病患者，局部伤口处理和肠造口治疗极为重要。对于其他形式的药物治疗无效的患者，英夫利昔单抗可能是一种有效的选择。造口重新定位仅用于其他治疗无效的持续性溃疡，因为造口周围坏疽性脓皮病可能在新的造口部位复发。
