Perez Rodrigo Oliva, Habr-Gama Angelita, Seid Victor E, Proscurshim Igor, Sousa Afonso H, Kiss Desidério R, Linhares Marcelo, Sapucahy Manuela, Gama-Rodrigues Joaquim
Institute of Colorectal Surgery, Rua Manuel da Nóbrega 1564, 04001-005 São Paulo, SP, Brazil.
Dis Colon Rectum. 2006 Oct;49(10):1539-45. doi: 10.1007/s10350-006-0645-8.
Diverting stomas are commonly performed during ileoanal and coloanal anastomoses. We studied a series of patients after loop ileostomy closure to determine risk factors and the impact of the interval from primary operation on morbidity.
Ninety-three consecutive patients undergoing loop ileostomy closure at a single institution after coloanal or ileoanal anastomosis were retrospectively reviewed. Complications were classified as medical or surgical according to its treatment requirements. Results were correlated to clinical and operative features.
Of the 93 patients, 43 were male and 50 were female with mean age of 56 years. Overall, complication rate was 17.2 percent. The most common complication was small-bowel obstruction. Complications required operative management in 3.2 percent and medical management alone in 14 percent. There was no mortality. There was no correlation between complication occurrence and age, gender, type of suture (manual or mechanical), and operative time. Complications were significantly associated with primary disease and shorter interval between primary operation and ileostomy closure. Regarding the optimal interval between primary surgery and ileostomy closure, the cutoff value for increased risk of developing postoperative complications was 8.5 weeks, below which the risk of such occurrence was significantly higher with a sensitivity rate of 88 percent.
Diverting loop ileostomy adds little cumulative morbidity to the primary operation and is a safe option for diversion to protect a low colorectal anastomosis. To further reduce morbidity, the interval between primary operation and ileostomy closure should be no shorter than 8.5 weeks.
在回肠肛管吻合术和结肠肛管吻合术中常进行转流性造口术。我们研究了一系列接受袢式回肠造口关闭术的患者，以确定危险因素以及初次手术间隔时间对发病率的影响。
回顾性分析了在单一机构接受结肠肛管或回肠肛管吻合术后行袢式回肠造口关闭术的93例连续患者。根据治疗需求将并发症分为内科或外科并发症。结果与临床和手术特征相关。
93例患者中，男性43例，女性50例，平均年龄56岁。总体并发症发生率为17.2%。最常见的并发症是小肠梗阻。3.2%的并发症需要手术处理，14%仅需内科处理。无死亡病例。并发症的发生与年龄、性别、缝合方式（手工或机械）及手术时间无关。并发症与原发病及初次手术至回肠造口关闭的间隔时间短显著相关。关于初次手术与回肠造口关闭的最佳间隔时间，术后并发症发生风险增加的临界值为8.5周，低于该值时此类并发症发生风险显著更高，敏感度为88%。
转流性袢式回肠造口术给初次手术增加的累积发病率较低，是保护低位结直肠吻合口的一种安全的转流选择。为进一步降低发病率，初次手术与回肠造口关闭的间隔时间不应短于8.5周。
