Moszkowicz David, Trésallet Christophe, Mariani Antoine, Lefevre Jérémie H, Godiris-Petit Gaëlle, Noullet Séverine, Rouby Jean-Jacques, Menegaux Fabrice
Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France.
Department of Visceral Surgery, St-Antoine Hospital (Assistance Publique-Hôpitaux de Paris), University Pierre et Marie Curie Paris 6, Paris, France.
Dig Liver Dis. 2014 Jun;46(6):505-11. doi: 10.1016/j.dld.2014.02.013. Epub 2014 Mar 18.
Acute ischaemic colitis can occur postoperatively, mainly after aortic surgery, or spontaneously. Surgical treatment is debated. Study aim was to describe factors related to ischaemic colitis severity, determine if postoperative and spontaneous ischaemic colitis share similar outcomes, and evaluate results of standardized management.
191 consecutive cases of ischaemic colitis observed from 1997 to 2012 were retrospectively analyzed: 119 (62%) after surgery and 72 (38%) spontaneous. Colon resection was performed for endoscopic type 2 colitis with multiple organ failure, and for every type 3. Types 1 and 2 without multiple organ failure were managed nonoperatively.
Seventeen patients (9%) were managed nonoperatively, without mortality. Mortality rate after resection was 48% (84/174), within 9 days (range, 0-152). Multivariate analysis found 2 independent factors associated with postoperative death: age≥75 years and multiple organ failure. The context in which ischaemic colitis occurred was not a risk factor for mortality. Mortality rates were 51% for final type 3 (66% with multiple organ failure, 17% without), 53% for final type 2 with multiple organ failure, and 0% for type 1 or type 2 without multiple organ failure.
An aggressive surgical approach in patients with ischaemic colitis seems justified in patients with multiple organ failure and findings of severe form of ischaemia at endoscopy.
急性缺血性结肠炎可在术后发生，主要是在主动脉手术后，也可自发发生。手术治疗存在争议。本研究的目的是描述与缺血性结肠炎严重程度相关的因素，确定术后缺血性结肠炎和自发性缺血性结肠炎的预后是否相似，并评估标准化管理的结果。
回顾性分析了1997年至2012年观察到的191例连续性缺血性结肠炎病例：119例（62%）为术后病例，72例（38%）为自发病例。对于伴有多器官功能衰竭的内镜2型结肠炎以及所有3型结肠炎均进行结肠切除术。对于无多器官功能衰竭的1型和2型结肠炎则采取非手术治疗。
17例患者（9%）接受了非手术治疗，无死亡病例。切除术后的死亡率为48%（84/174），在9天内（范围为0 - 152天）。多因素分析发现与术后死亡相关的2个独立因素：年龄≥75岁和多器官功能衰竭。缺血性结肠炎发生的背景不是死亡的危险因素。最终为3型的死亡率为51%（伴有多器官功能衰竭的为66%，无多器官功能衰竭的为17%），伴有多器官功能衰竭的最终为2型的死亡率为53%，无多器官功能衰竭的1型或2型的死亡率为0%。
对于伴有多器官功能衰竭且内镜检查发现严重缺血形式的缺血性结肠炎患者，采取积极的手术方法似乎是合理的。
