Fry P D, Atkinson K G
Surg Gynecol Obstet. 1976 Jul;143(1):26-30.
Presented evidence illustrates that proctocolectomy performed as an emergency procedure is frequently less than adequate in salvaging patients with toxic megacolon, and a current mortality of 27 per cent is recorded. The mortality and morbidity of this disease are directly related to the delay in recognition and treatment of this complication and to iatrogenic perforation of the colon during colectomy, which results in fecal peritonitis. This is particularly evident when definitive operation is postponed for more than five days after the initial diagnosis of toxic megacolon. The rationale of current adherence to proctocolectomy for this complication is questioned, and a plea is made for the recognition of the life-saving potential for ileostomy-colostomy for selected patients and also for closer and earlier collaboration between surgeon and internist during the management of these patients.
现有证据表明，作为急诊手术进行的直肠结肠切除术在挽救中毒性巨结肠患者方面往往不够充分，目前记录的死亡率为27%。这种疾病的死亡率和发病率直接与该并发症的识别和治疗延迟以及结肠切除术期间结肠的医源性穿孔有关，这会导致粪性腹膜炎。当在中毒性巨结肠初步诊断后将确定性手术推迟超过五天时，这一点尤为明显。目前对于该并发症坚持进行直肠结肠切除术的基本原理受到质疑，有人呼吁认识到为特定患者进行回肠造口术-结肠造口术的挽救生命潜力，以及在这些患者的管理过程中外科医生和内科医生之间更密切、更早的合作。
