Johnson W R, Hughes E S, McDermott F T, Pihl E A, Katrivessis H
Surg Gynecol Obstet. 1986 May;162(5):421-5.
A total of 1,494 patients with a diagnosis of ulcerative colitis were managed by one surgeon between 1950 and 1981. Subtotal colectomy was performed upon 286 patients of whom 82 had a primary and 65 a secondary ileorectal anastomosis. There was no significant difference in the postoperative mortalities between patients treated by subtotal colectomy (8.7 per cent) and a group of 71 patients treated by proctocolectomy (9.9 per cent). The postoperative mortality after primary and secondary ileorectal anastomosis was 6.9 and 1.5 per cent, respectively. Rectal excision because of disease activity was required in 109 patients after subtotal colectomy (13 after primary and nine after secondary ileorectal anastomosis) with a postoperative mortality of 0.5 per cent. The probability of rectal excision was 21 per cent at 12.6 years after primary anastomosis and 19 per cent at 16.2 years after secondary ileorectal anastomosis. Carcinoma of the rectum has developed in 11 (3.8 per cent) of the patients after subtotal colectomy. The probability of having carcinoma of the rectum develop was 17.1 per cent at 27 years after primary anastomosis and 20.0 per cent at 24 years after secondary ileorectal anastomoiss, the time beyond which no disease has yet been diagnosed in either group. The disease was advanced in stage and of high histologic grade with a median cancer specific survival time of 14 months.
1950年至1981年间，一名外科医生共诊治了1494例溃疡性结肠炎患者。286例患者接受了结肠次全切除术，其中82例行一期回肠直肠吻合术，65例行二期回肠直肠吻合术。结肠次全切除术患者的术后死亡率（8.7%）与71例接受全直肠结肠切除术患者的术后死亡率（9.9%）之间无显著差异。一期和二期回肠直肠吻合术后的死亡率分别为6.9%和1.5%。结肠次全切除术后，109例患者（一期回肠直肠吻合术后13例，二期回肠直肠吻合术后9例）因疾病活动需要行直肠切除术，术后死亡率为0.5%。一期吻合术后12.6年直肠切除的概率为21%，二期回肠直肠吻合术后16.2年直肠切除的概率为19%。结肠次全切除术后，11例患者（3.8%）发生了直肠癌。一期吻合术后27年发生直肠癌的概率为17.1%，二期回肠直肠吻合术后24年发生直肠癌的概率为20.0%，两组在该时间之后均未诊断出疾病。疾病分期较晚，组织学分级较高，癌症特异性中位生存时间为14个月。
