Tsujikawa Tomoyuki, Andoh Akira, Sakaki Masaya, Ishizuka Izumi, Araki Yoshio, Koyama Shigeki, Fujiyama Yoshihide
Division of Gastroenterology, Shiga University of Medical Science, Shiga, Japan.
Hepatogastroenterology. 2005 Sep-Oct;52(65):1470-3.
BACKGROUND/AIMS: The failure of medical treatment for severe ulcerative colitis (UC) can result in an emergency colectomy. Since new treatments using cyclosporin A and leukocytapheresis have been developed, we analyzed historical changes in the operative indications for UC.
We retrospectively reviewed the medical record of 40 patients who underwent surgery, and analyzed the medical treatments before surgery using two groups (urgent and elective) and two time periods (1986-1999, 2000-2003).
The number of patients who received operations in the severe UC group from 1986 to 1999 was 17 out of 23 patients, but this number decreased from 2000 to 2003. Although 40% of the patients from 2000 to 2003 in the refractory UC group had been treated with steroids only, the mean times of high-dose steroid therapy decreased from 4.3 to 2.5. The total amount of steroids administered in both groups tended to decrease from 2000 onwards. The postoperative questionnaire indicated that about half of them felt that their surgery had been performed too late.
The number of emergency colectomies for severe UC has been decreasing with the introduction of new therapies, but gastroenterologists should carefully monitor the potentially adverse effects of steroids for refractory UC.
背景/目的：重症溃疡性结肠炎（UC）内科治疗失败可能导致急诊结肠切除术。自从开发出使用环孢素A和白细胞去除术的新治疗方法以来，我们分析了UC手术指征的历史变化。
我们回顾性研究了40例接受手术患者的病历，并使用两组（急诊和择期）和两个时间段（1986 - 1999年，2000 - 2003年）分析了术前的内科治疗情况。
1986年至1999年，重症UC组中有17例患者接受了手术，占23例患者中的比例，但从2000年到2003年这一数字有所下降。尽管2000年至2003年难治性UC组中40%的患者仅接受了类固醇治疗，但高剂量类固醇治疗的平均次数从4.3次降至2.5次。从2000年起，两组中类固醇的给药总量均呈下降趋势。术后问卷调查显示，约一半的患者认为他们的手术做得太晚了。
随着新疗法的引入，重症UC急诊结肠切除术的数量一直在减少，但胃肠病学家应仔细监测类固醇对难治性UC的潜在不良反应。
