Goligher J C, Hoffman D C, de Dombal F T
Br Med J. 1970 Dec 19;4(5737):703-6. doi: 10.1136/bmj.4.5737.703.
The management and outcome of 258 severe attacks of ulcerative colitis from 1952 to 1969 has been reviewed. If remission did not occur during an initial course of intensive medical treatment, including administration of corticosteroids, operation (generally ileostomy with proctocolectomy or subtotal colectomy) was performed. This took place some 12 to 17 days after admission as a rule during the years 1952-63, but usually within five to seven days from 1964 to 1969.Roughly half the attacks underwent spontaneous remission during the two periods, but the medical mortality was 4.8% in the former and 0.7% in the latter, the operative mortality 20.0 and 7.0%, and the overall mortality 11.3 and 4.5% respectively. The lowering of the mortality was particularly striking in severe first attacks and in severe attacks in patients over 60 years of age.Perforation of the colon was found in 21 cases, or nearly 20% of 112 patients coming to operation during attacks, being commoner in the first period (32.5%) than in the second (11.1%). The immediate mortality of all such operations was 11.6%; in cases with perforation it was 28.6%.Acute colonic dilatation was observed in 28 cases. All but one were treated by emergency colectomy, at which the colon was noted to be perforated in 11. The mortality of these operations was 18.5%.Follow-up of the 140 patients who survived without coming to operation during their attacks shows that 52 (37.1%) subsequently underwent surgical treatment either during further attacks or electively.Though all 258 attacks were thought at the time to be due to ordinary ulcerative colitis, subsequent pathological examination of operative specimens derived from 98 patients who came to urgent or subsequent operation during the 1964-9 period revealed that the lesion in the large bowel was Crohn's disease in 17 instances.
对1952年至1969年间258例重症溃疡性结肠炎发作的治疗及结果进行了回顾。如果在包括使用皮质类固醇在内的强化初始治疗过程中未出现缓解，则进行手术（一般为回肠造口术加直肠结肠切除术或次全结肠切除术）。在1952 - 1963年期间，通常在入院约12至17天后进行手术，但在1964年至1969年期间，通常在五至七天内进行。在这两个时期，约一半的发作出现了自发缓解，但前期的医疗死亡率为4.8%，后期为0.7%，手术死亡率分别为20.0%和7.0%，总体死亡率分别为11.3%和4.5%。死亡率的降低在严重的首次发作以及60岁以上患者的严重发作中尤为显著。在发作期间接受手术的112例患者中，有21例发现结肠穿孔，占近20%，前期（32.5%）比后期（11.1%）更为常见。所有此类手术的即时死亡率为11.6%；有穿孔的病例中为28.6%。观察到28例急性结肠扩张。除1例患者外，所有患者均接受了急诊结肠切除术，其中11例术中发现结肠穿孔。这些手术的死亡率为18.5%。对140例在发作期间未接受手术而存活的患者进行随访发现，其中52例（37.1%）随后在进一步发作期间或择期接受了手术治疗。尽管当时认为所有258例发作均由普通溃疡性结肠炎引起，但对1964 - 1969年期间98例因紧急情况或后续手术而接受手术的患者的手术标本进行后续病理检查发现，17例患者的大肠病变为克罗恩病。
