Strauss R J, Flint G W, Platt N, Levin L, Wise L
Ann Surg. 1976 Dec;184(6):682-8. doi: 10.1097/00000658-197612000-00004.
Experience with 28 patients with toxic dilatation of the colon is reviewed. The operative mortality in this series was 32% (9/28). Eight of the 9 patients who died were found to have colonic perforations at operation; in contrast, the group of patients with no perforations had a mortality rate of only 6%. Colonic perforation and sepsis were the most significant factors contributing to mortality and morbidity in this series. A review of the literature showed an overall operative mortality rate of 19.5% for patients with toxic megacolon; the mortality rate was 41% for patients with perforations and 8.8% for patients without perforations. It appears that the keystone to successful management is the avoidance of colonic perforation and sepsis; protracted medical management of toxic megacolon seems to have been at least partly responsible for these complications. Sixteen of the 18 survivors following subtotal colectomy required removal of the rectum within 9 months because of continued symptoms and disease in the rectal stump.
回顾了28例结肠中毒性扩张患者的治疗经验。该系列患者的手术死亡率为32%（9/28）。死亡的9例患者中有8例在手术中发现有结肠穿孔；相比之下，无穿孔患者组的死亡率仅为6%。结肠穿孔和脓毒症是导致该系列患者死亡和发病的最重要因素。文献回顾显示，中毒性巨结肠患者的总体手术死亡率为19.5%；有穿孔患者的死亡率为41%，无穿孔患者的死亡率为8.8%。成功治疗的关键似乎是避免结肠穿孔和脓毒症；中毒性巨结肠的长期内科治疗似乎至少部分导致了这些并发症。18例接受结肠次全切除术后存活的患者中，有16例因直肠残端持续出现症状和疾病，在9个月内需要切除直肠。
