Fulminant Amebic Colitis: Recommended Treatment to Improve Survival

猛爆性阿巴大腸炎:改善預後的建議治療

陳華宗(Hwa-Tzong Chen) ； 許永祥(Yung-Hsiang Hsu) ； 張耀仁(Yao-Zen Chang)

《慈濟醫學雜誌》 16卷1期 (2004/02) Pp. 1-8

https://doi.org/10.6440/TZUCMJ.200402.0001

摘要

目的:本研究旨於迴溯性分析猛爆性阿米巴大腸炎的臨床症狀，癥候及比較保守治療和手術治療對疾病預後的影響。病人與方法：本研究取材於1994年元月至200年6月間，花蓮慈濟醫院15例猛爆性阿米巴大腸炎個案的回溯分析。其中9例接受持性內科治療，另外6例接受外科手術治療，結果：15例病患中，男性占12例，女性有3例，平均年齡51歲。最常見臨床表徵包括：腹痛、嚴重腹瀉、發燒及缺水；最主要的病理發現，急性發炎、大腸壞死、內含滋養體及大腸穿孔。比較支持性內科治療及外手術治療病患的臨床數據包括臨床表徵、投於阿米巴藥物治療時間，血紅素、白蛋白、白血球及年齡，這兩者之間並無顯著差別。診斷3例存活，但另外6例亡(死亡率占66.7%，全部病例的死亡率為40%)。我們發現在支持性治療的病一組，死亡病例的年齡較存活者年齡高(分別為55.1歲及41.7歲)。且死亡病例自發病至治療時間較久(分別為10.2天及5天)。因此年紀大、延宕抗阿米巴藥物治療可能是影響病人預後的兩項重要危險因素。結論：一旦且疑似有併發症發生，應考慮緊急根治性手術治療。

關鍵字

猛爆性阿巴大腸炎 ； 阿米巴疾病 ； 阿米巴痢疾

並列摘要

Objective: This study was retrospectively designed to present the clinical manifestations and histopathologic features of fulminant amebic colitis, and to evaluate the impact on the outcome of both surgical and conservative treatments. Patients and Methods: A retrospective analysis was conducted from clinical and histopathologic data of 15 patients with fulminant amebic colitis. Nine patients received conservative management, and 6 underwent surgery. Data were obtained from medical records from January 1994 to June 2000. Results: There were 12 men and 3 women with a median age of 51 years. The most frequent clinical manifestations were abdominal pain, severe diarrhea, fever, unstable vital signs, and dehydration. The main histopathologic features were acute inflammation, necrosis, the presence of trophozoites, and perforation. No significant difference was found in the clinical features between the conservative group and surgical group, including clinical manifestations, duration before the use of metronidazole, hemoglobin and albumin levels, white cell count, and age. The most reliable diagnostic procedure was endoscopic biopsy. All 6 patients who underwent surgery survived (6/6). Of the 9 cases that received conservative treatment, only 3 survived (mortality rate 66.7%, overall mortality rate 40%). The average age of expired and surviving patients was 55.1 and 41.7 years, respectively. The average duration before antiamebic treatment of expired patients and surviving cases was 10 and 5 days, respectively. Older age and longer duration before antiamebic treatment appeared to impact the mortality in our series. Conclusions: Early diagnosis, and aggressive supportive and antiamebic treatment should be instituted once acute amebic colitis is suspected. Prompt aggressive surgical management is recommended for the management of complicated acute fulminant amebic colitis.

並列關鍵字

fulminant amebic colitis ； amebiasis ； amebic dysentery