Levitt M D, Ritchie J K, Lennard-Jones J E, Phillips R K
St. Mark's Hospital, London, UK.
Br J Surg. 1991 Jun;78(6):676-8. doi: 10.1002/bjs.1800780613.
Since 1954, 34 patients have attended St. Mark's Hospital with pyoderma gangrenosum in association either with ulcerative colitis (22 patients) or Crohn's disease (12 patients). Lesions were multiple in 71 per cent and over half were situated below the knees. Ulcerative colitis was active in 11 patients (50 per cent) and Crohn's disease was active in nine (75 per cent) when pyoderma gangrenosum was diagnosed. Associated illnesses--most commonly a seronegative arthritis affecting large joints--were present in 55 per cent and 92 per cent of cases respectively. A diffuse pustular rash appeared in six patients, synchronously with pyoderma in five. In a further seven patients (two with ulcerative colitis, five with Crohn's disease) the onset or course of pyoderma might have been linked to the presence of non-dermatological suppuration. Pyoderma resolved without intestinal resection in two-thirds of patients. When present at the time of surgical resection (15 procedures in 13 patients), pyoderma healed promptly in six cases, only with additional therapy in four cases and very slowly or not at all in five cases. Pyoderma gangrenosum occurs in both ulcerative colitis and Crohn's disease. Healing after intestinal resection is unpredictable both with respect to timing and extent of resection.
自1954年以来，34例患有坏疽性脓皮病的患者前往圣马克医院就诊，这些患者同时患有溃疡性结肠炎（22例）或克罗恩病（12例）。71%的患者病损为多发，超过半数位于膝盖以下。诊断坏疽性脓皮病时，11例（50%）溃疡性结肠炎患者病情处于活动期，9例（75%）克罗恩病患者病情处于活动期。分别有55%和92%的病例存在相关疾病，最常见的是累及大关节的血清阴性关节炎。6例患者出现弥漫性脓疱疹，其中5例与坏疽性脓皮病同时出现。另外7例患者（2例溃疡性结肠炎患者，5例克罗恩病患者）坏疽性脓皮病的起病或病程可能与非皮肤性化脓有关。三分之二的患者未行肠道切除，坏疽性脓皮病即痊愈。在手术切除时出现坏疽性脓皮病的患者（13例患者接受了15次手术）中，6例患者的坏疽性脓皮病迅速愈合，4例患者仅在接受额外治疗后愈合，5例患者愈合非常缓慢或根本未愈合。溃疡性结肠炎和克罗恩病均可发生坏疽性脓皮病。肠道切除术后的愈合情况在切除时机和范围方面均不可预测。
