Hartong W A, Arvanitakis C, Skibba R M, Klotz A P
Am J Dig Dis. 1977 Mar;22(3):195-200. doi: 10.1007/BF01072276.
A review of 29 patients with toxic megacolon complicating ulcerative colitis was undertaken to (1) compare the results of medical and surgical treatment; (2) determine the optimal timing for surgical intervention, and (3) identify possible precipitating factors. Twenty-one patients were treated medically with nasogastric suction, steroids, parental fluids, blood transfusions, and antimicrobial agents. Of the 21 patients, 11 (53%) showed improvement by subjective and objective criteria and 10 (47%) failed to respond. Sixteen patients were treated surgically. This group was subdivided into 8 patients who failed to respond to medical treatment and 8 treated surgically. Total proctocolectomy with ileostomy was performed in 8 and subtotal colectomy and ileoproctostomy in 8, with subsequent proctectomy and ileostomy in 6 patient. Six of 8 patients (75%) treated primarily surgically improved, and 2 (25%) died. Seven of 8 patients (87.5%) treated surgically after failure of medical trial showed definite postoperative improvement, and 1 (12.5%) failed. Those who were operated on within the first 48-72 hr after the diagnosis of toxic megacolon was made responded uniformly well. Anticholinergics, opiates,, barium enema, and colonoscopy were identified as possible precipitating factors in 70% of cases. The results of this tudy in this patient population indicate that early surgical therapy in toxic megacolon is associated with better results than medical therapy (P less than 0.025). Although intensive, optimal medical therapy plays a significant role in the management of toxic megacolon, failure to induce rapid improvement within 48-72 hr constitutes an indication for definitive surgical treatment.
对29例合并溃疡性结肠炎的中毒性巨结肠患者进行了回顾性研究，目的是：（1）比较内科治疗和外科治疗的结果；（2）确定手术干预的最佳时机；（3）找出可能的诱发因素。21例患者接受内科治疗，包括鼻胃管吸引、类固醇、胃肠外补液、输血和抗菌药物。在这21例患者中，11例（53%）根据主观和客观标准显示病情改善，10例（47%）无反应。16例患者接受了手术治疗。该组又分为8例内科治疗无效患者和8例直接接受手术治疗患者。8例行全直肠结肠切除加回肠造口术，8例行次全结肠切除加回肠直肠吻合术，其中6例随后行直肠切除术加回肠造口术。8例直接接受手术治疗的患者中有6例（75%）病情改善，2例（25%）死亡。8例在内科治疗失败后接受手术治疗的患者中有7例（87.5%）术后病情明显改善，1例（12.5%）无效。在诊断中毒性巨结肠后的最初48 - 72小时内接受手术的患者均反应良好。70%的病例中，抗胆碱能药物、阿片类药物、钡剂灌肠和结肠镜检查被确定为可能的诱发因素。该患者群体的这项研究结果表明，中毒性巨结肠的早期手术治疗比内科治疗效果更好（P < 0.025）。虽然强化的最佳内科治疗在中毒性巨结肠的管理中起着重要作用，但在48 - 72小时内未能迅速改善则表明需要进行确定性手术治疗。
