Greenstein A J, Aufses A H
Surg Gynecol Obstet. 1985 Jan;160(1):63-9.
We have studied the patient records of 49 or 1,623 patients in whom perforation occurred during the course of inflammatory intestinal disease. Perforation occurred most commonly with toxic megacolon in UC, but without toxic megacolon in Crohn's disease of the colon. The incidence of perforation was significantly greater in UC than in Crohn's disease involving the colon. This was due primarily to the higher incidence of perforations with toxic megacolon in the former. The incidence of toxic megacolon was significantly greater in ulcerative colitis than in Crohn's disease involving the colon (CC and IC) and in UC than in ileocolitis. Although almost twice as frequent in UC than in Crohn's colitis alone, a significant difference could not be demonstrated in this series for patients with UC compared with CC. In UC, the incidence of perforation was 28 times as frequent if toxic colonic dilation occurred, compared with ten times the frequency of TCD in Crohn's disease involving the colon. There was a significantly higher incidence of perforation in patients with UC with toxic megacolon. The incidence of colonic perforation in the absence of toxic megacolon was similar in the two series (7 of 552 for UC, 1.2 per cent, versus 11 of 607 for CDC, 1.8 per cent). Mortality was no different in toxic megacolon in patients with UC compared with those with Crohn's disease or in patients with UC with free perforation compared with those with sealed perforation. Mortality was significantly greater in patients with perforation in UC than in those with Crohn's disease in the absence of toxic megacolon. All 15 patients with spontaneous free perforation in Crohn's disease treated by resection or exteriorization with diversion survived compared with four of seven deaths of free perforation in UC. We have no explanation for the remarkable difference in survival of free perforation in the absence of toxic megacolon in UC and CD, but it may be due to differing immunologic states or pathogenetic mechanisms.
我们研究了1623例炎症性肠病患者中的49例患者记录，这些患者在病程中发生了穿孔。穿孔最常见于溃疡性结肠炎（UC）合并中毒性巨结肠的患者，但在结肠克罗恩病患者中穿孔发生时不伴有中毒性巨结肠。UC患者的穿孔发生率明显高于累及结肠的克罗恩病患者。这主要是由于前者中毒性巨结肠导致穿孔的发生率更高。溃疡性结肠炎患者中毒性巨结肠的发生率明显高于累及结肠的克罗恩病（包括结肠型克罗恩病和未定型结肠炎），且UC患者中毒性巨结肠的发生率高于回结肠型克罗恩病。虽然UC患者中毒性巨结肠的发生率几乎是单纯克罗恩结肠炎患者的两倍，但在本系列研究中，UC患者与结肠型克罗恩病患者相比，差异无统计学意义。在UC中，如果发生中毒性结肠扩张，穿孔发生率是其28倍，而在累及结肠的克罗恩病中，中毒性结肠扩张导致穿孔的发生率是其10倍。UC合并中毒性巨结肠患者的穿孔发生率明显更高。两个系列中，无中毒性巨结肠时结肠穿孔的发生率相似（UC患者552例中有7例，占1.2%；结肠型克罗恩病患者607例中有11例，占1.8%）。UC合并中毒性巨结肠患者的死亡率与克罗恩病患者相比无差异，UC患者游离穿孔与闭合穿孔患者相比死亡率也无差异。在无中毒性巨结肠的情况下，UC患者穿孔的死亡率明显高于克罗恩病患者。克罗恩病15例自发性游离穿孔患者接受切除或外置转流术治疗后全部存活，而UC患者7例游离穿孔中有4例死亡。对于UC和克罗恩病在无中毒性巨结肠时游离穿孔患者生存率的显著差异，我们无法给出解释，但这可能是由于免疫状态或发病机制不同所致。
