Prolonged preoperative hospitalization correlates with worse outcomes after colectomy for acute fulminant ulcerative colitis
Prolonged preoperative hospitalization correlates with worse outcomes after colectomy for acute fulminant ulcerative colitis
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DOI：
10.1016/j.surg.2012.08.002
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发表时间：
2013-02-01
期刊：
影响因子：
3.8
通讯作者：
Divino, Celia M.
中科院分区：
文献类型：
--
作者：
Coakley, Brian A.;Telem, Dana;Divino, Celia M.
背景虽然全腹结肠切除术一直被认为是药物治疗难治性暴发性溃疡性结肠炎的决定性治疗方法，但手术的最佳时机仍存在争议。早期手术治疗对急性溃疡性结肠炎患者可能有益。我们的目的是比较结肠切除术治疗暴发性溃疡性结肠炎的结果，并确定预测预后不良的术前因素。回顾性分析了2004年至2009年间107例暴发性溃疡性结肠炎患者行全腹结肠切除回肠造口术的病历资料。29例患者发生严重术后并发症; 78例患者顺利恢复。采用Student t检验、Fisher精确检验和卡方（2）分析比较围手术期统计、30天再入院/再手术率、围手术期发病率和死亡率。发生术后并发症的患者入院时的白色血细胞计数显著较高，但在患者特征、其他急性疾病指标或疾病程度方面没有差异。单变量分析显示，发生术后并发症的患者进行结肠切除术的时间明显晚于那些顺利恢复的患者（3.6 vs 7.4天; P = 0.01）。腹腔镜结肠切除术所需时间明显长于开腹手术，但不影响术后发病率。多变量分析显示，术前药物治疗的持续时间是术后发病风险增加的唯一重要预测因素。随访数据显示两组患者最终行回肠贮袋肛门吻合术的比例相似（IPAA; 68% vs 77%; P =.5）。暴发性溃疡性结肠炎行全腹结肠切除术后，术前药物治疗时间延长与术后不良结局相关。此外，持续的术后并发症并没有阻止患者最终接受IPAA。（Surgery 2013; 153：242 - 8.）
Background. Although total abdominal colectomy has long been considered definitive treatment for fulminant ulcerative colitis refractory to medical management, the optimal timing of surgery remains controversial. Early surgical intervention may be beneficial to patients with acute ulcerative colitis. Our goal was to compare outcomes after colectomy for fulminant ulcerative colitis and to identify preoperative factors that are predictive of poor outcome.Methods. The charts of 107 patients treated by total abdominal colectomy with ileostomy for fulminant ulcerative colitis between 2004 and 2009 were retrospectively reviewed. Twenty-nine patients sustained a major postoperative complication; 78 patients recovered uneventfully. Perioperative statistics, 30-day readmission/reoperation rates, and perioperative morbidity and mortality were compared using the Student t and Fisher exact tests and chi(2) analysis where appropriate.Results. White blood cell count at admission was significantly higher among patients who developed postoperative complications, but there were no differences in patient characteristics, other acute illness measures, or disease extent. Univariate analysis revealed that patients who developed postoperative complications underwent colectomy significantly later (3.6 vs 7.4 days; P = .01) than those who recovered uneventfully. Laparoscopic colectomy took significantly longer than open surgery, but did not affect postoperative morbidity. Multivariate analysis revealed duration of preoperative medical treatment to be the only significant predictor of increased risk of postoperative morbidity. Follow-up data revealed that similar percentages of patients in both groups eventually underwent ileal pouch anal anastomosis (IPAA; 68% vs 77%; P = .5).Conclusion. Prolonged duration of preoperative medical treatment correlates with poor postoperative outcomes after total abdominal colectomy for fulminant ulcerative colitis. In addition, sustaining postoperative complications did not prevent patients from eventually undergoing IPAA. (Surgery 2013;153:242-8.)