Joh Yong-Geul, Lindsetmo Rolv-Ole, Stulberg Jonah, Obias Vincent, Champagne Brad, Delaney Conor P
Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA.
Dis Colon Rectum. 2008 Dec;51(12):1786-9. doi: 10.1007/s10350-008-9399-9. Epub 2008 Jun 24.
In this study we evaluated the outcome of a standardized enhanced recovery program in patients undergoing ileostomy closure.
Forty-two patients underwent ileostomy closure by a single surgeon and were managed by a standardized postoperative care pathway. On the first postoperative day, patients received oral analgesia and a soft diet. Discharge was based on standard criteria previously published for laparoscopic colectomy patients. Results were recorded prospectively in an Institutional Review Board-approved database, including demographics, operative time, blood loss, complications, length of stay, and readmission data.
The median operative time and blood loss were 60 minutes and 17.5 mL, respectively, and median hospital stay was 2 days. Twenty-nine patients (69 percent) were discharged by postoperative Day 2. The complication rate was 23.8 percent; complications included prolonged postoperative ileus (n = 3), early postoperative small-bowel obstruction (n = 1), mortality not related to ileostomy closure (n = 1), minor bleeding (n = 1), wound infection (n = 1), incisional hernia (n = 1), diarrhea (n = 1), dehydration (n = 1). The 30-day readmission rate was 9.5 percent (n = 4). Two patients had reoperation within 30 days for small-bowel obstruction and a wound infection.
Ileostomy closure patients managed with postoperative care pathways can have a short hospital stay with acceptable morbidity and readmission rates.
在本研究中，我们评估了标准化加速康复计划在接受回肠造口关闭术患者中的效果。
42例患者由同一位外科医生进行回肠造口关闭术，并按照标准化的术后护理路径进行管理。术后第一天，患者接受口服镇痛治疗并进食软食。出院依据先前公布的腹腔镜结肠切除术患者的标准标准。结果前瞻性记录在机构审查委员会批准的数据库中，包括人口统计学资料、手术时间、失血量、并发症、住院时间和再入院数据。
中位手术时间和失血量分别为60分钟和17.5毫升，中位住院时间为2天。29例患者（69%）在术后第2天出院。并发症发生率为23.8%；并发症包括术后肠梗阻延长（n = 3）、术后早期小肠梗阻（n = 1）、与回肠造口关闭无关的死亡（n = 1）、少量出血（n = 1）、伤口感染（n = 1）、切口疝（n = 1）、腹泻（n = 1）、脱水（n = 1）。30天再入院率为9.5%（n = 4）。2例患者在30天内因小肠梗阻和伤口感染接受了再次手术。
采用术后护理路径管理的回肠造口关闭术患者住院时间短，发病率和再入院率可接受。
