Sakai L, Keltner R, Kaminski D
Am J Surg. 1980 Dec;140(6):755-60. doi: 10.1016/0002-9610(80)90111-7.
Ischemic changes in the colon that progress to gangrene present diagnostic and therapeutic difficulties associated with poor survival. During the past 10 years, 36 patients with colonic ischemia were treated. Two clinical groups were evident. The spontaneous ischemic colitis group (type I) included 17 patients who were well before the onset of gastrointestinal symptoms. The cause of type I ischemic colitis is not apparent; it is attributed to occlusive or nonocclusive ischemia. The other group (type II) included 19 patients who developed ischemia of the colon associated with shock secondary to various disease processes. Radiographic evidence of distended bowel correlated well with full-thickness necrosis as determined clinically or pathologically. Twenty-one patients died, for a mortality rate of 58 percent. While full-thickness gangrene was fatal in 71 percent of the patients, mucosal necrosis only was associated with an 88 percent survival rate. The results of treatment should improve with an increased awareness of ischemic colitis, earlier appropriate operative intervention, and more appropriate use of ileostomy and colostomy.
进展为坏疽的结肠缺血性改变会带来诊断和治疗方面的困难，且预后较差。在过去10年中，对36例结肠缺血患者进行了治疗。明显分为两个临床组。自发性缺血性结肠炎组（I型）包括17例在出现胃肠道症状之前情况良好的患者。I型缺血性结肠炎的病因尚不明确，归因于闭塞性或非闭塞性缺血。另一组（II型）包括19例因各种疾病过程继发休克而发生结肠缺血的患者。肠道扩张的影像学证据与临床或病理确定的全层坏死密切相关。21例患者死亡，死亡率为58%。虽然全层坏疽在71%的患者中是致命的，但仅黏膜坏死的患者存活率为88%。随着对缺血性结肠炎认识的提高、更早进行适当的手术干预以及更合理地使用回肠造口术和结肠造口术，治疗结果应该会有所改善。
