Wells A D, McMillan I, Price A B, Ritchie J K, Nicholls R J
St. Mark's Hospital, London, UK.
Br J Surg. 1991 Feb;78(2):179-81. doi: 10.1002/bjs.1800780214.
The long-term outcome of patients with a pathological diagnosis of indeterminate colitis on a colectomy specimen was investigated. The case records of 46 such patients operated on for inflammatory bowel disease between 1960 and 1983 were reviewed. Using the preoperative clinical information, pathological and radiological reports, it was possible to divide the patients into three groups: group 1, probable Crohn's disease (19 cases); group 2, probable ulcerative colitis (11 cases); and group 3, indeterminate colitis (16 cases). The patients were followed for a minimum of 2.5 years (median 10, range 2.5-28 years). During this period the probable diagnosis changed in five cases only. One patient in group 1 (Crohn's disease) was subsequently considered to have ulcerative colitis (group 2). The other four patients were all in group 3. Three were reclassified as ulcerative colitis and the fourth as Crohn's disease on the finding of a single granuloma in a rectal biopsy. No case in group 3 required subsequent small bowel surgery. These data suggest that patients continuing with a diagnosis of indeterminate colitis in spite of careful preoperative and postoperative assessment are unlikely to show features of Crohn's disease in the long term. This may be important when considering a subsequent restorative proctectomy.
对结肠切除术标本病理诊断为不确定性结肠炎患者的长期预后进行了研究。回顾了1960年至1983年间因炎症性肠病接受手术的46例此类患者的病例记录。利用术前临床信息、病理和放射学报告，可将患者分为三组：第1组，可能为克罗恩病（19例）；第2组，可能为溃疡性结肠炎（11例）；第3组，不确定性结肠炎（16例）。对患者进行了至少2.5年的随访（中位时间10年，范围2.5 - 28年）。在此期间，仅5例患者的可能诊断发生了变化。第1组（克罗恩病）中的1例患者后来被认为患有溃疡性结肠炎（第2组）。其他4例患者均在第3组。3例因直肠活检发现单个肉芽肿而重新分类为溃疡性结肠炎，第4例重新分类为克罗恩病。第3组中无一例患者随后需要进行小肠手术。这些数据表明，尽管术前和术后进行了仔细评估，但持续诊断为不确定性结肠炎的患者长期来看不太可能出现克罗恩病的特征。这在考虑后续的保留直肠切除术时可能很重要。
