Massachusetts General Hospital, Department of Surgery, 15 Parkman Street, ACC 460, Boston, MA 02114, USA; The Johns Hopkins Hospital, Department of Surgery, Baltimore, MD, USA.
Massachusetts General Hospital, Department of Surgery, 15 Parkman Street, ACC 460, Boston, MA 02114, USA.
Am J Surg. 2014 Feb;207(2):281-7. doi: 10.1016/j.amjsurg.2013.06.006. Epub 2013 Oct 8.
Surgeons frequently discourage patients with ulcerative colitis from having surgery in the midst of an acute flare for fear of complications and poor long-term outcomes.
Outcomes of patients undergoing urgent versus elective surgery for ulcerative colitis were compared via retrospective review.
Patients undergoing urgent (n = 80) versus elective (n = 99) surgery were younger, were more malnourished, had more severe active disease, and had higher steroid use (P ≤ .05). During surgery, hemodynamic stability was similar, but urgent patients underwent more subtotal colectomies (5.1% vs 29%, P < .0001) and fewer laparoscopic procedures (8.8% vs 18%, P = .07). Multivariate regression suggested that short-term complications were increased with higher body mass index and urgency status (P ≤ .05). Anastomotic leaks and long-term complications were similar between groups. Surgeon inexperience and use of immunomodulators other than infliximab were associated with increased odds of long-term fistula/abscess (odds ratio, 5.56; P = .05] and pouch failure (odds ratio, 13.3; P = .01).
Surgery in patients with acute ulcerative colitis flares is associated with more short-term complications than elective procedures but does not appear to affect risk for anastomotic leak or long-term complications when performed by an expert.
外科医生经常劝阻溃疡性结肠炎患者在急性发作期间进行手术，因为担心并发症和长期预后不佳。
通过回顾性研究比较了溃疡性结肠炎患者紧急手术与择期手术的结果。
与择期手术（n = 99）相比，紧急手术（n = 80）的患者更年轻，营养不良更严重，疾病更严重，皮质类固醇使用更多（P ≤.05）。手术期间，血流动力学稳定性相似，但紧急手术组行全结肠切除术的比例更高（5.1% vs 29%，P <.0001），腹腔镜手术的比例更低（8.8% vs 18%，P =.07）。多变量回归表明，短期并发症与较高的体重指数和紧急状态相关（P ≤.05）。吻合口漏和长期并发症在两组之间相似。手术医生经验不足和使用除英夫利昔单抗以外的免疫调节剂与长期瘘管/脓肿（优势比，5.56；P =.05）和 pouch 失败（优势比，13.3；P =.01）的风险增加相关。
在急性溃疡性结肠炎发作期间进行手术与更多的短期并发症相关，而与经验丰富的外科医生进行手术时，并不增加吻合口漏或长期并发症的风险。
