Early colectomy in steroid-refractory acute severe ulcerative colitis improves operative outcome
Early colectomy in steroid-refractory acute severe ulcerative colitis improves operative outcome
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DOI：
10.1007/s00384-017-2903-8
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发表时间：
2018-01-01
影响因子：
2.8
通讯作者：
Sahni, Peush
中科院分区：
文献类型：
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作者：
Saha, Sujeet Kumar;Panwar, Rajesh;Sahni, Peush
多达三分之一的急性严重溃疡性结肠炎(ASUC)患者对强化类固醇治疗无效，最终需要挽救结肠切除术。我们以前曾报道过，急诊结肠切除术的死亡率可以通过在强化内科治疗的第一周内提供来降低。我们实施了这一政策，并报告了我们的经验结果。从2005年1月至2015年7月期间，所有因药物治疗失败而接受急诊结肠切除术的ASUC患者的临床记录从前瞻性维护的数据库中提取。对这些数据进行了分析，包括强化医疗治疗的持续时间、手术时机、住院死亡率和术后并发症。88名患者在药物治疗失败后接受了ASUC的紧急手术。其中75例(85.2%)在强化治疗开始后7天内手术，51例(58%)在5天内手术。1例患者在激素治疗后第8天手术，术后死亡。目前的手术后死亡率为1.1%(1/88)，显著低于以前记录的病例系列中的死亡率[8/51(15.6%)；p=0.001]。此外，与7天内手术的患者相比，7天后手术的患者的总体并发症(9/13比23/75；p=0.012)和临床显著并发症(12/75比6/13；p=0.022)的发生率显著增加。对于对强化类固醇治疗无效的急性结直肠癌患者，在7天内进行早期结肠切除术的策略改善了围手术期的结果，住院死亡率和发病率显著降低。
Up to a third of patients with acute severe ulcerative colitis (ASUC) fail to respond to intensive steroid therapy and eventually require a salvage colectomy. We have previously reported that the mortality of emergency colectomy can be decreased by offering it within the first week of intensive medical therapy. We implemented this policy and report the results of our experience.The clinical records of all patients with ASUC who underwent emergency colectomy after failure of medical therapy between January 2005 and July 2015 were extracted from a prospectively maintained database. The data were analysed with regard to duration of intensive medical therapy, timing of surgery, in-hospital mortality and post-operative complications.Eighty-eight patients underwent emergency surgery for ASUC after failed medical therapy. Of these, 75 (85.2%) were operated within 7 days of initiation of intensive medical therapy [n = 51 (58%) were operated < 5 days]. One patient who was operated on day 8 following steroid therapy died postoperatively. The current post-operative mortality of 1.1% (1/88) was significantly lower than the mortality noted in the previously recorded retrospective case series [8/51 (15.6%); p = 0.001]. In addition, the incidence of overall (9/13 vs. 23/75; p = 0.012) and clinically significant (12/75 vs. 6/13; p = 0.022) complications was significantly higher in patients operated after 7 days as compared to those operated within 7 days.The policy of early colectomy, within 7 days, in patients with ASUC who fail to respond to intensive steroid-based therapy improves perioperative outcomes with significantly low in-hospital mortality and morbidity.