Grant C S, Dozois R R
Am J Surg. 1984 Jan;147(1):106-10. doi: 10.1016/0002-9610(84)90042-4.
The clinical course and ultimate outcome in 38 patients with toxic megacolon who were successfully treated nonoperatively has been reviewed. Thirty-two patients had ulcerative colitis and 6 had Crohn's disease. Follow-up was complete and ranged from 3 to 22 years (average 13 years). Eleven of 38 patients (29 percent) eventually suffered second episode of fulminant acute colitis or recurrent toxic megacolon. Ultimately, a total of 18 patients (47 percent) underwent colon resection, which was performed on an emergency or urgent basis in 15 patients. A modified Visick classification was employed to assess the long-term results of medical therapy in the entire group, in patients showing improvement within 48 or 72 hours, in patients 30 years or younger, in patients whose initial presentation of inflammatory bowel disease was toxic megacolon, and in patients with ulcerative colitis as opposed to Crohn's disease. The results were equally poor for all subgroups, and they have strengthened our opinion that medical management of toxic megacolon should be regarded almost exclusively as preparation for imminent surgery.
回顾了38例非手术成功治疗的中毒性巨结肠患者的临床病程及最终结局。32例患者患有溃疡性结肠炎，6例患有克罗恩病。随访完整，时间跨度为3至22年（平均13年）。38例患者中有11例（29%）最终出现暴发性急性结肠炎或复发性中毒性巨结肠的第二次发作。最终，共有18例患者（47%）接受了结肠切除术，其中15例患者是在急诊或紧急情况下进行的。采用改良的Visick分类法评估整个组、48或72小时内病情改善的患者、30岁及以下的患者、最初表现为炎症性肠病为中毒性巨结肠的患者以及患有溃疡性结肠炎而非克罗恩病的患者的内科治疗长期结果。所有亚组的结果同样不佳，这强化了我们的观点，即中毒性巨结肠的内科治疗几乎应仅被视为即将进行手术的准备。
