Huguier Michel, Barrier Alain, Boelle Pierre Y, Houry Sydney, Lacaine Francois
Department of General and Digestive Surgery, Tenon Hospital, University P. and M. Curie, 4 rue de la Chine, 75020, Paris, France.
Am J Surg. 2006 Nov;192(5):679-84. doi: 10.1016/j.amjsurg.2005.09.018.
Ischemic colitis almost always occurs in older patients. Because life expectancy is increasing, more and more often physicians will face this problem. The aim of this study was to identify factors leading to surgery in the acute phase of the disease, and to evaluate mortality and long-term follow-up evaluation.
We performed a retrospective study of 73 patients (mean age, 73 y) in the Department of General and Digestive Surgery. Diagnosis was obtained by endoscopic and pathologic procedures. The median follow-up period was 4.5 years (range, 2-9 y).
Thirty-six patients had 1 or more co-existing medical diseases. All the patients had either lower intestinal bleeding (45 patients) or diarrhea (28 patients). Thirty-three patients had undergone surgery (45%). In the surgical group, 13 patients underwent immediate surgery for abdominal tenderness and/or shock. Eight of these patients died (62%). Out of 60 patients undergoing nonsurgical immediate management, 1 patient died (septic shock). Delayed surgery was indicated in 20 out of the 59 remaining patients for clinical or endoscopic aggravation. Six of these patients died (30%). Multivariate analysis selected 4 factors of severity: age younger than 80 years, male sex, absence of bleeding, and abdominal tenderness. In the follow-up period 13 patients died from a cardiovascular disease. The 2- and 5-year actuarial survival rates of patients who survived the initial hospitalization were 88% and 68%, respectively.
Multivariate analysis selected the risk factors of severity. In severely ill patients serial endoscopic evaluations are the best indicator for surgery before appearance of tenderness, septic shock, full-thickness gangrene, and perforation. At discharge, anticoagulant or anti-arrhythmic therapy should be considered for patients who have cardiovascular disease.
缺血性结肠炎几乎总是发生在老年患者中。由于预期寿命的增加，医生越来越多地会面临这个问题。本研究的目的是确定导致疾病急性期手术的因素，并评估死亡率和长期随访情况。
我们对普通外科和消化外科的73例患者（平均年龄73岁）进行了回顾性研究。通过内镜和病理检查进行诊断。中位随访期为4.5年（范围2 - 9年）。
36例患者有一种或多种并存的内科疾病。所有患者均有下消化道出血（45例）或腹泻（28例）。33例患者接受了手术（45%）。在手术组中，13例患者因腹部压痛和/或休克接受了急诊手术。其中8例患者死亡（62%）。在60例接受非手术即刻处理的患者中，1例患者死亡（感染性休克）。其余59例患者中有20例因临床或内镜检查病情加重而接受了延期手术。其中6例患者死亡（30%）。多因素分析筛选出4个严重程度因素：年龄小于80岁、男性、无出血和腹部压痛。在随访期间，13例患者死于心血管疾病。初次住院存活患者的2年和5年精算生存率分别为88%和68%。
多因素分析筛选出了严重程度的危险因素。在重症患者中，系列内镜检查是在出现压痛、感染性休克、全层坏疽和穿孔之前进行手术的最佳指标。出院时，对于患有心血管疾病的患者应考虑抗凝或抗心律失常治疗。
