Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, UK.
Br J Surg. 2010 Mar;97(3):404-9. doi: 10.1002/bjs.6874.
This study determined the long-term outcome after colectomy for acute severe ulcerative colitis (ASUC) and assessed whether the duration of in-hospital medical therapy is related to postoperative outcome.
All patients who underwent urgent colectomy and ileostomy for ASUC between 1994 and 2000 were identified from a prospective database. Patient details, preoperative therapy and complications to last follow-up were recorded.
Eighty patients were identified, who were treated with intravenous steroids for a median of 6 (range 1-22) days before surgery. Twenty-three (29 per cent) also received intravenous ciclosporin. There were 23 complications in 22 patients in the initial postoperative period. Sixty-eight patients underwent further planned surgery, including restorative ileal pouch-anal anastomosis in 57. During a median follow-up of 5.4 (range 0.5-9.0) years, 48 patients (60 per cent) developed at least one complication. Patients with a major complication at any time during follow-up had a significantly longer duration of medical therapy before colectomy than patients with no major complications (median 8 versus 5 days; P = 0.036).
Delayed surgery for patients with ASUC who do not respond to medical therapy is associated with an increased risk of postoperative complications.
本研究旨在确定急性重度溃疡性结肠炎（ASUC）患者行结肠切除术的长期预后，并评估住院期间的药物治疗时间是否与术后结果相关。
从前瞻性数据库中确定了 1994 年至 2000 年间因 ASUC 而行紧急结肠切除术和造口术的所有患者。记录患者详细信息、术前治疗和随访结束时的并发症。
共确定了 80 例患者，这些患者在手术前接受静脉类固醇治疗的中位数为 6 天（范围为 1-22 天）。23 例（29%）患者还接受了静脉环孢素治疗。22 例患者在初始术后期间有 23 种并发症。68 例患者接受了进一步的计划手术，其中 57 例接受了可恢复性回肠袋肛管吻合术。在中位数为 5.4 年（范围为 0.5-9.0 年）的随访中，48 例患者（60%）至少发生了一次并发症。与无重大并发症的患者相比，在随访期间任何时间发生重大并发症的患者，在接受结肠切除术前的药物治疗时间明显更长（中位数为 8 天 vs 5 天；P=0.036）。
对药物治疗无效的 ASUC 患者延迟手术与术后并发症风险增加相关。
