Delayed surgery for acute severe colitis is associated with increased risk of postoperative complications
Delayed surgery for acute severe colitis is associated with increased risk of postoperative complications
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DOI：
10.1002/bjs.6874
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发表时间：
2010-03-01
影响因子：
9.6
通讯作者：
George, B. D.
中科院分区：
文献类型：
--
作者：
Randall, J.;Singh, B.;George, B. D.
背景：本研究确定急性重度溃疡性结肠炎（ASUC）患者结肠切除术后的长期预后，并评估住院治疗时间是否与术后预后相关。方法：从前瞻性数据库中确定1994年至2000年间因ASUC接受紧急结肠切除术和回肠造口术的所有患者。记录患者详细情况、术前治疗情况及术后并发症。结果：确定了80例患者，他们在手术前接受静脉注射类固醇治疗的中位数为6天（范围为1-22天）。23人（29%）还接受了静脉注射环孢素。22例患者术后初期出现23例并发症。68例患者接受了进一步的计划手术，其中57例进行了恢复性回肠袋-肛门吻合术。在中位随访5.4年（0.5-9.0年）期间，48例患者（60%）出现至少一种并发症。随访期间任何时间有主要并发症的患者在结肠切除术前的药物治疗时间明显长于无主要并发症的患者（中位8天和5天；P = 0.036）。结论：药物治疗无效的ASUC患者延迟手术与术后并发症风险增加相关。
Background: This study determined the long-term outcome after colectomy for acute severe ulcerative colitis (ASUC) and assessed whether the duration of in-hospital medical therapy is related to postoperative outcome.Methods: All patients who underwent urgent colectomy and ileostomy for ASUC between 1994 and 2000 were identified from a prospective database. Patient details, preoperative therapy and complications to last follow-up were recorded.Results: Eighty patients were identified, who were treated with intravenous steroids for a median of 6 (range 1-22) days before surgery. Twenty-three (29 per cent) also received intravenous ciclosporin. There were 23 complications in 22 patients in the initial postoperative period. Sixty-eight patients underwent further planned surgery, including restorative ileal pouch-anal anastomosis in 57. During a median follow-up of 5.4 (range 0.5-9.0) years, 48 patients (60 per cent) developed at least one complication. Patients with a major complication at any time during follow-up had a significantly longer duration of medical therapy before colectomy than patients with no major complications (median 8 versus 5 days; P = 0.036).Conclusion: Delayed surgery for patients with ASUC who do not respond to medical therapy is associated with an increased risk of postoperative complications.