溃疡性结肠炎患者手术治疗预测因素分析

Analysis for Factors Predicting Surgical Therapy in Patients with Ulcerative Colitis

背景:手术是溃疡性结肠炎(UC)内科治疗无效或发生严重并发症者的治疗选择。目的:分析UC患者行手术治疗的可能预测因素方法:纳入1998年8月～2009年9月北京协和医院住院UC患者312例,其中34例接受手术治疗,278例接受非手术治疗,回顾性分析、比较两组患者的各类临床资料结果:住院UC患者手术率为10.9%,手术死亡率为5.9%,重度UC患者手术率为23.9%。手术组13例患者为激索抵抗,8例为激素依赖,9例发生严重并发症,4例激素治疗有效者主动要求手术治疗手术组平均住院次数显著多于非手术组(P<0.05),术前Hb、白蛋白显著低于非手术组(P<0.05),CRP显著高于非手术组(P<0.05),重度结肠炎、全结肠炎患者比例显著高于非手术组(P<0.05)。结论:疾病严重程度高、病变范围广、对激素抵抗的UC患者,手术需求增加。

Surgery is a treatment option for ulcerative colitis （UC） patients with no response to medical treatment or having serious complications. Aims： To analyze the possible predictive factors for surgical therapy in UC patients. Methods： Clinical data of 312 UC in-patients, including 34 surgically treated patients and 278 non-surgically treated patients from Aug. 1998 to Sep. 2009 in Peking Union Medical College Hospital were analyzed retrospectively. Results： The surgical treatment rate in UC in-patients was 10.9%, and the mortality was 5.9%. The surgical treatment rate in patients with severe UC was 23.9%. Of the surgically treated patients, 13 were steroid-resistance, 8 were steroid- dependence, 9 had severe complications, and 4 with response to steroids requested surgery. Frequency of hospitalization was much higher in surgically treated group than that in non-surgically treated group （P〈0.05）. Preoperative hemoglobin and albumin in surgically treated group were significantly lower than those in non-surgically treated group （P〈0.05）, while CRP was signifieandy higher than that in non-surgically treated group （P〈0.05）. Proportions of patients with severe disease and pan-colitis in surgically treated group were significantly higher than those in non-surgically treated group （P〈O.05）. Conclusions： UC patients with severe disease, wide range of intestinal segment involvement and resistant to steroids, have an increased requirement for surgical therapy.