Tjandra J J, Hughes L E
Department of Surgery, University of Wales College of Medicine, Cardiff, United Kingdom.
Dis Colon Rectum. 1994 Sep;37(9):938-42. doi: 10.1007/BF02052602.
Parastomal pyoderma gangrenosum is uncommon and its association with inflammatory bowel disease is unclear. This is a review of five patients with parastomal pyoderma gangrenosum.
A retrospective review of five patients with ulcerative colitis (two patients) or Crohn's disease (three patients) who have been seen in one surgical unit was conducted.
All patients were females and each presented within nine months of abdominal surgery and stoma construction. All had active proctitis (n = 3) or perianal Crohn's disease (n = 2). Both patients with perianal Crohn's disease had a mild clinical course with healing of parastomal pyoderma gangrenosum when treated with steroids with and without low-dose cyclosporin A. They both had curettage of the perineal wound as well. In the remaining three patients with active proctitis, the parastomal lesions failed to resolve despite high-dose systemic steroids. By contrast, the parastomal pyoderma gangrenosum healed promptly in two of these patients following proctectomy for active proctitis.
The variable clinical outcome of parastomal pyoderma gangrenosum may be related to the activity of the underlying inflammatory bowel disease or possibly to low-grade perineal sepsis.
造口周围坏疽性脓皮病并不常见，其与炎症性肠病的关联尚不清楚。本文对5例造口周围坏疽性脓皮病患者进行了回顾性分析。
对在一个外科单元就诊的5例溃疡性结肠炎患者（2例）或克罗恩病患者（3例）进行回顾性研究。
所有患者均为女性，均在腹部手术及造口术后9个月内发病。所有患者均有活动性直肠炎（3例）或肛周克罗恩病（2例）。2例肛周克罗恩病患者临床症状较轻，使用类固醇及联合小剂量环孢素A治疗后，造口周围坏疽性脓皮病愈合。她们还均接受了会阴伤口刮除术。其余3例活动性直肠炎患者，尽管使用了大剂量全身类固醇治疗，造口周围病变仍未消退。相比之下，其中2例活动性直肠炎患者在接受直肠切除术后，造口周围坏疽性脓皮病迅速愈合。
造口周围坏疽性脓皮病的临床结局各异，可能与潜在炎症性肠病的活动度有关，也可能与低度会阴感染有关。
