Kaiser Andreas M, Israelit Shlomo, Klaristenfeld Daniel, Selvindoss Paul, Vukasin Petar, Ault Glenn, Beart Robert W
Department of Colorectal Surgery, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Suite 7418, Los Angeles, CA 90033, USA.
J Gastrointest Surg. 2008 Mar;12(3):437-41. doi: 10.1007/s11605-007-0457-8. Epub 2007 Dec 20.
Creation of a temporary ostomy is a surgical tool to divert stool from a more distal area of concern (anastomosis, inflammation, etc). To provide a true benefit, the morbidity/mortality from the ostomy takedown itself should be minimal. The aim of our study was therefore to evaluate our own experience and determine the complications and mortality of stoma closure in relation to the type and location of the respective ostomy.
Patients undergoing an elective takedown of a temporary ostomy at our teaching institution between January 1999 and July 2005 were included in our analysis, and the medical records were retrospectively reviewed. Excluded were only patients with relevant chart deficiencies and nonelective stoma revisions/takedowns. Data collected included general demographics; the type and location of the stoma; the operative technique; and the type, timing, and impact of complications. Perioperative morbidity was defined as complications occurring within 30 days from the operation.
156 patients (median age 45 years, range 18-85) were included in the analysis: 31 loop and 59 end colostomy reversals and 56 loop and 10 end ileostomy takedowns. Mean follow-up was 6 months. The overall mortality rate was low (0.65%, 1/156 patients). However, the morbidity rate was 36.5% (57 patients), with 6 (3.8%) systemic complications and 51 (32.7%) local complications. Minor would infection (34 patients, 21.8%) and postoperative ileus (9 patients, 5.7%) were the most common surgery-related complications, but they generally resolved with conservative management. Anastomotic leak and formation/persistence of an enterocutaneous fistula (6 patients, 3.8%) were the most serious local complications and required reintervention in all of the patients. Closure of a loop colostomy accounted for half and Hartmann reversals for one third of these complications, as opposed to ileostomy takedowns, which accounted for only one sixth (1.8% absolute risk).
Takedown of a temporary ostomy has a low mortality but a nonnegligible morbidity. The stoma location (large vs. small bowel) has a higher impact than the type of stoma construction (end vs. loop) on the incidence and severity of complications.
创建临时造口是一种手术手段，用于使粪便从更远处的关注区域（吻合口、炎症等）改道。为了带来真正的益处，造口回纳本身的发病率/死亡率应降至最低。因此，我们研究的目的是评估我们自己的经验，并确定与相应造口的类型和位置相关的造口关闭的并发症和死亡率。
对1999年1月至2005年7月在我们教学机构接受择期临时造口回纳的患者进行分析，并对病历进行回顾性审查。仅排除有相关病历缺陷以及非择期造口修复/回纳的患者。收集的数据包括一般人口统计学资料；造口的类型和位置；手术技术；以及并发症的类型、时间和影响。围手术期发病率定义为术后30天内发生的并发症。
156例患者（中位年龄为45岁，范围18 - 85岁）纳入分析：31例袢式结肠造口回纳和59例端式结肠造口回纳，以及56例袢式回肠造口回纳和10例端式回肠造口回纳。平均随访时间为6个月。总体死亡率较低（0.65%，1/156例患者）。然而，发病率为36.5%（57例患者），其中全身并发症6例（3.8%），局部并发症51例（32.7%）。轻微伤口感染（34例患者，21.8%）和术后肠梗阻（9例患者，5.7%）是最常见的手术相关并发症，但通常通过保守治疗得以解决。吻合口漏和肠造口皮肤瘘的形成/持续存在（6例患者，3.8%）是最严重的局部并发症，所有患者均需再次干预。这些并发症中，袢式结肠造口关闭占一半，哈特曼回纳占三分之一，而回肠造口回纳仅占六分之一（绝对风险1.8%）。
临时造口回纳死亡率低，但发病率不可忽视。造口位置（大肠与小肠）对并发症的发生率和严重程度的影响高于造口构建类型（端式与袢式）。
