Department of Colorectal Surgery, Clinical Research Center for Intestinal and Colorectal Diseases of Hubei Province, Hubei Key Laboratory of Intestinal, Colorectal Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China.
Chin Med J (Engl). 2013 Mar;126(5):949-56.
This review discusses the current status and progress in studies on fulminant Clostridium difficile colitis (FCDC), including the definition, risk factor, diagnostic role of CT, surgical treatment, postoperative mortality, and new therapeutic strategy.
A literature search was conducted mainly in Medline and PubMed published in English between January 2000 and May 2011. The search terms were "ulminant Clostridium difficile colitis" "reatment", "urgery" and "ortality"
Recent studies show that the overall mortality rate for FCDC remains high despite early surgical intervention. It has been difficult to identify the real value for surgical intervention in patients with FCDC due to the absence of prospective, randomized studies. Early recognition of patients with FCDC will help a clinician decide the need for treatment in an intensive care setting, multi-disciplinary consultation, and appropriate therapeutic selection. Some studies emphasize the importance of early recognition and emergent surgery at a less severe stage. Monoclonal antibody therapy and intravenous immunoglobulin treatment may be useful for the treatment of FCDC.
Present studies do not provide strong evidence for guiding the surgical treatment of FCDC; hence, creation of collaborative research networks is crucial in order to undertake large prospective multi-center studies for improvement in overall survival.
本文综述了暴发性艰难梭状芽孢杆菌结肠炎（FCDC）的研究现状和进展，包括其定义、危险因素、CT 的诊断作用、手术治疗、术后死亡率和新的治疗策略。
主要在 Medline 和 PubMed 中检索 2000 年 1 月至 2011 年 5 月发表的英文文献，检索词为“fulminant Clostridium difficile colitis”“treatment”“surgery”和“mortality”。
最近的研究表明，尽管早期进行手术干预，FCDC 的总体死亡率仍然很高。由于缺乏前瞻性、随机研究，因此很难确定手术干预在 FCDC 患者中的真正价值。早期识别 FCDC 患者有助于临床医生决定是否需要在重症监护环境下进行治疗、多学科咨询以及适当的治疗选择。一些研究强调了在疾病较轻阶段早期识别和紧急手术的重要性。单克隆抗体治疗和静脉注射免疫球蛋白治疗可能对 FCDC 的治疗有用。
目前的研究没有为指导 FCDC 的手术治疗提供强有力的证据；因此，创建协作研究网络对于开展大型前瞻性多中心研究以提高总体生存率至关重要。
