Robert J H, Sachar D B, Aufses A H, Greenstein A J
Department of Surgery, Mount Sinai School of Medicine, City University of New York.
Am J Surg. 1990 Jun;159(6):550-5. doi: 10.1016/s0002-9610(06)80064-4.
Twenty-five patients with ulcerative colitis were treated between 1959 and 1986 at the Mount Sinai Hospital, with severe gastrointestinal hemorrhage as their major complaint. Twenty-two patients required operation, while three patients were treated medically. Total proctocolectomy with ileostomy was carried out in 5 patients, and subtotal colectomy accompanied by mucous fistula (14), Hartmann closure (2), or ileosigmoidostomy (1) was performed in 17 patients. Eleven of the patients who underwent operation had emergency colectomies, while the remaining 11 had semielective procedures. Subtotal colectomy was performed in 10 of the 11 emergency cases. Indications for emergency surgery were massive hemorrhage alone in seven patients and severe hemorrhage complicated by toxic megacolon in four patients. One patient died postoperatively of a perforated duodenal ulcer following emergency subtotal colectomy. There were two late deaths from leukemia in one surgically treated patient and one medically treated patient at 9 and 18 months, respectively. All 4 of the 25 patients with remaining intact rectums were alive and well at 3- to 12-year follow-up. Subtotal colectomy can be undertaken in patients with massive hemorrhage from ulcerative colitis for whom subsequent ileoanal anastomosis is planned, provided that one recognizes and is prepared for the approximately 12% risk of continued rectal hemorrhage.
1959年至1986年期间，西奈山医院对25例溃疡性结肠炎患者进行了治疗，这些患者主要以严重胃肠道出血为主诉。22例患者需要手术治疗，3例患者接受药物治疗。5例患者行全直肠结肠切除术并回肠造口术，17例患者行次全结肠切除术，分别伴有黏液瘘（14例）、Hartmann闭合术（2例）或回肠乙状结肠吻合术（1例）。接受手术的患者中有11例行急诊结肠切除术，其余11例行半选择性手术。11例急诊病例中有10例行次全结肠切除术。急诊手术的指征为7例患者仅出现大量出血，4例患者出现严重出血并伴有中毒性巨结肠。1例患者在急诊次全结肠切除术后因十二指肠溃疡穿孔死亡。1例接受手术治疗的患者和1例接受药物治疗的患者分别在9个月和18个月时因白血病晚期死亡。在对25例直肠完整的患者进行3至12年的随访中，所有患者均存活且状况良好。对于计划随后进行回肠肛管吻合术的溃疡性结肠炎大量出血患者，可进行次全结肠切除术，但前提是要认识到并为约12%的持续性直肠出血风险做好准备。
