Remzi Feza H, Fazio Victor W, Gorgun Emre, Ooi Boon S, Hammel Jeff, Preen Miriam, Church James M, Madbouly Khaled, Lavery Ian C
Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Dis Colon Rectum. 2006 Apr;49(4):470-7. doi: 10.1007/s10350-006-0509-2.
Controversy exists regarding the safety for omission of diverting ileostomy in restorative proctocolectomy because of fears of increased septic complications. This study was designed to evaluate the outcomes of restorative proctocolectomy in a consecutive series of patients by comparing postoperative complications, functional results, and quality of life in patients with and without diverting ileostomy.
Data regarding demographics, length of stay, surgical characteristics, and complications were reviewed and recorded according to the presence (n= 1,725) or absence (n = 277) of a diverting ileostomy at the time of pelvic pouch surgery. Criteria for omission of ileostomy included: stapled anastomosis, tension-free anastomosis, intact tissue rings, good hemostasis, absence of airleaks, malnutrition, toxicity, anemia, and prolonged consumption of steroids. Functional outcome and quality of life indicators were prospectively recorded and compared.
Patients in the ileostomy group had greater body surface area and older mean age at time of surgery, were taking greater doses of steroids preoperatively, and required more blood transfusions at the time of surgery compared with the one-stage (P < 0.05). There were no differences between the two groups in septic complications (P > 0.05). Early postoperative ileus was more common in the one-stage group (P < 0.001). There were no differences between the groups in quality of life and functional outcomes.
For carefully selected patients undergoing restorative proctocolectomy with ileal pouch-anal anastomosis, omission of diverting ileostomy is a safe procedure that does not lead to an increase in septic complications or mortality. Quality of life and functional results are similar to those who undergo ileal pouch-anal anastomosis with diversion, provided that certain selection factors are considered.
由于担心感染性并发症增加，对于在直肠结肠切除术后省略转流性回肠造口术的安全性存在争议。本研究旨在通过比较有或无转流性回肠造口术患者的术后并发症、功能结果和生活质量，评估一系列连续患者行直肠结肠切除术的结果。
根据盆腔袋手术时是否存在转流性回肠造口术（存在组n = 1725；不存在组n = 277），回顾并记录人口统计学、住院时间、手术特征和并发症的数据。省略回肠造口术的标准包括：吻合器吻合、无张力吻合、组织环完整、止血良好、无漏气、无营养不良、无中毒、无贫血以及未长期使用类固醇。前瞻性记录并比较功能结果和生活质量指标。
与一期手术组相比，回肠造口术组患者手术时体表面积更大、平均年龄更大，术前服用类固醇剂量更大，手术时需要更多输血（P < 0.05）。两组在感染性并发症方面无差异（P > 0.05）。一期手术组术后早期肠梗阻更常见（P < 0.001）。两组在生活质量和功能结果方面无差异。
对于精心挑选的行回肠贮袋肛管吻合术的直肠结肠切除术患者，省略转流性回肠造口术是一种安全的手术，不会导致感染性并发症或死亡率增加。只要考虑某些选择因素，生活质量和功能结果与行转流性回肠贮袋肛管吻合术的患者相似。
