Ali Syed O, Welch John P, Dring Robert J
University of Connecticut Integrated General Surgery Program, Farmington, Connecticut, USA.
Am Surg. 2008 Jan;74(1):20-6. doi: 10.1177/000313480807400105.
The objective of this study of a retrospective case series was to determine factors associated with survival after surgical intervention in pseudomembranous colitis (PMC). The study was conducted at a tertiary care medical center and comprised 36 patients who underwent colectomy for fulminant PMC from 1995 to 2006. Patients including 21 females ranged from 40 to 89 years of age (mean, 70 years). Comorbidities included diabetes (39%), cardiovascular disease (77%), chronic obstructive pulmonary disease (47%), and intake of immunosuppressive medications (45%). Seventy-two per cent received antibiotics in the previous 2 months. Only patients with a confirmation of PMC on pathology specimens were included in the study. All patients underwent colectomy. Patients were stratified into two groups: survivors and nonsurvivors. Various clinical factors/ parameters used in the management of patients with PMC were studied in these two groups. Survival was correlated with mean white blood cell count (23,000 survivors versus 40,000 nonsurvivors, P < 0.01); multisystem organ failure (16 per cent survivors versus 47 per cent nonsurvivors, P < 0.05); and preoperative pressors (16 per cent survivors versus 47 per cent nonsurvivors, P < 0.05). Overall mortality for the study period was 47 per cent. Mortality rate analysis revealed a lower rate for the more recent years (32 per cent for 2000 to 2006 versus 65 per cent for 1995 to 1999, P < 0.05). In the more recent years, the time elapsing before colectomy was also lower (1.4 days versus 2.5 days, nonsignificant), and patients had less preoperative hemodynamic instability (70 per cent versus 31 per cent, P < 0.03). In one institution, survival after surgery for PMC was found to be associated with a mean white blood cell count (< 37,000), nondependence on preoperative vasopressors, and surgical intervention before the onset of hemodynamic instability.
本回顾性病例系列研究的目的是确定与伪膜性结肠炎（PMC）手术干预后生存相关的因素。该研究在一家三级医疗中心进行，纳入了1995年至2006年间因暴发性PMC接受结肠切除术的36例患者。患者年龄在40至89岁之间（平均70岁），包括21名女性。合并症包括糖尿病（39%）、心血管疾病（77%）、慢性阻塞性肺疾病（47%）以及服用免疫抑制药物（45%）。72%的患者在过去2个月内接受过抗生素治疗。只有病理标本确诊为PMC的患者被纳入研究。所有患者均接受了结肠切除术。患者被分为两组：存活者和非存活者。在这两组中研究了PMC患者管理中使用的各种临床因素/参数。生存与平均白细胞计数相关（存活者为23,000，非存活者为40,000，P<0.01）；多系统器官衰竭（存活者为16%，非存活者为47%，P<0.05）；以及术前使用升压药（存活者为16%，非存活者为47%，P<0.05）。研究期间的总体死亡率为47%。死亡率分析显示近年来死亡率较低（2000年至2006年为32%，而1995年至1999年为65%，P<0.05）。近年来，结肠切除术前的时间间隔也较短（1.4天对2.5天，无显著差异），且患者术前血流动力学不稳定的情况较少（70%对31%，P<0.03）。在一家机构中，发现PMC手术后的生存与平均白细胞计数（<37,000）、不依赖术前血管升压药以及在血流动力学不稳定发作前进行手术干预有关。
