Butala Parag, Divino Celia M
Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA.
Am J Surg. 2010 Jul;200(1):131-5. doi: 10.1016/j.amjsurg.2009.07.040. Epub 2010 Apr 21.
Clostridium difficile-associated disease (CDAD) is responsible for the majority of nosocomial diarrhea, and fulminant C difficile colitis can have mortality upwards of 80%. Early identification and treatment of fulminant C difficile colitis is critical to patient care, but timing of surgical intervention remains difficult. This review summarizes the epidemiology, predictors of development, and management of fulminant C difficile colitis.
A literature search was conducted between January 1989 and May 2009 using the keywords "clostridium difficile colitis" or "fulminant clostridium difficile colitis" and "surgery." Articles not in English, those not involving human subjects, and case reports were excluded.
Early diagnosis and treatment with subtotal colectomy and end ileostomy is critical in reducing the mortality associated with fulminant colitis. Patients who have a history of inflammatory bowel disease (IBD), recent surgery, prior treatment with intravenous immunoglobulin (IVIG), vasopressor requirements, leukocytosis, or increased lactate should have early surgical consultation and operative intervention.
艰难梭菌相关性疾病(CDAD)是大多数医院获得性腹泻的病因,暴发性艰难梭菌结肠炎的死亡率可达80%以上。早期识别和治疗暴发性艰难梭菌结肠炎对患者护理至关重要,但手术干预的时机仍很困难。本综述总结了暴发性艰难梭菌结肠炎的流行病学、发病预测因素及治疗方法。
于1989年1月至2009年5月期间进行文献检索,关键词为“艰难梭菌结肠炎”或“暴发性艰难梭菌结肠炎”以及“手术”。排除非英文文章、不涉及人类受试者的文章及病例报告。
早期诊断并采用结肠次全切除术及末端回肠造口术进行治疗对于降低暴发性结肠炎相关死亡率至关重要。有炎症性肠病(IBD)病史、近期接受过手术、先前接受过静脉注射免疫球蛋白(IVIG)治疗、需要使用血管加压药、白细胞增多或乳酸水平升高的患者应尽早接受外科会诊及手术干预。