Sugár István, István Gábor, Szabó Akos, Tulassay Eszter, Ondrejka Pál, Szabolcs Zoltán
Semmelweis Egyetem II. sz. Sebészeti Klinika Budapest.
Magy Seb. 2005 Dec;58(6):398-401.
In the last 2 years 9 patients have been operated on in our surgical department because of colon necrosis which developed after open heart surgery. The symptoms--abdominal distension, circumscript peritonitis in the right lower part of the abdomen--developed 2-4 days after the heart operation. Laparotomies were carried out within 2 days from the onset of symptoms in all but one patient. In 7 patients the necrosis of the right colon, while in 2 other patients extreme dilatation of the colon was found. In 6 patients right hemicolectomy was carried out. One operation was finished without anastomosis with double stomas. In the 2 patients with no necrosis catheter-cecostomy was performed. All patients but one after hemicolectomy with reconstruction died after several reoperations because of suture leak. The other 3 patients were cured. We examined and analysed the pre-, intra- and postoperative circumstances of the heart operations, which lead to the severe complications. We think the cause of the problems was the liberal use of wide spectrum antibiotics with caused severe dysbacteriosis and Clostridium difficile toxicosis in the colon. This condition could lead to a pseudomembraneous colitis which resulted in the colon necrosis.
在过去两年中，我们外科有9名患者因心脏直视手术后发生结肠坏死而接受手术。症状——腹胀、右下腹局限性腹膜炎——在心脏手术后2至4天出现。除1名患者外，所有患者均在症状出现后2天内进行了剖腹手术。7例患者为右半结肠坏死，另外2例患者发现结肠极度扩张。6例患者进行了右半结肠切除术。1例手术未进行吻合，而是做了双造口。2例无坏死的患者进行了导管盲肠造口术。除1例患者外，所有接受半结肠切除重建术的患者均在多次再次手术后因缝线渗漏死亡。另外3例患者治愈。我们检查并分析了导致严重并发症的心脏手术的术前、术中和术后情况。我们认为问题的原因是广泛使用广谱抗生素导致结肠严重菌群失调和艰难梭菌中毒。这种情况可能导致假膜性结肠炎，进而导致结肠坏死。
