Baraza W, Wild J, Barber W, Brown S
Department of Surgical and Anaesthetic Sciences, University of Sheffield, Sheffield, UK.
Ann R Coll Surg Engl. 2010 Jan;92(1):51-5. doi: 10.1308/003588410X12518836439209.
Recent studies have shown that closure of loop ileostomy can be performed in the day-case setting, reducing the length and cost of hospitalisation. By analysing our patients who have undergone reversal, we aimed to determine the length of hospital stay and potential factors behind stays beyond 24 h.
A database of patients undergoing closure of loop ileostomy at one colorectal unit was examined. The times taken to discharge, morbidity and re-admission rates were recorded.
Eighty patients underwent reversal of ileostomy between January 2001 and January 2006. Median age was 63 years (range, 22-81 years). The median length of stay was 4 days (range, 2-32 days). The median length of stay in patients without complications was 4 days. Many appeared able to be discharged earlier. Seventy-two patients (90%) were able to tolerate a solid diet within 48 h and 54 (67.5%) had bowel function within 3 days. Six patients went home before bowel function; none of these were re-admitted. Twenty patients (25%) developed complications, which included wound infection (8%), small bowel obstruction/ileus (6%), enterocutaneous fistula (1%), anastomotic leak (1%), and late abdominal wall abscess (1%). Of the patients, 16% stayed longer than 5 days despite having no postoperative complications.
The majority of patients undergoing loop ileostomy reversal at our institution can be discharged earlier than they are at present. Support in the community and the implementation of modified UK day-case surgery protocols are suggested to help shorten patients' length of stay.
近期研究表明，袢式回肠造口关闭术可在日间手术环境下进行，从而缩短住院时间并降低住院费用。通过分析我们接受回肠造口还纳术的患者，我们旨在确定住院时间以及超过24小时住院时间背后的潜在因素。
对某一结直肠科接受袢式回肠造口关闭术的患者数据库进行了检查。记录了出院时间、发病率和再入院率。
2001年1月至2006年1月期间，80例患者接受了回肠造口还纳术。中位年龄为63岁（范围22 - 81岁）。中位住院时间为4天（范围2 - 32天）。无并发症患者的中位住院时间为4天。许多患者似乎能够更早出院。72例患者（90%）在48小时内能够耐受固体饮食，54例患者（67.5%）在3天内恢复肠道功能。6例患者在肠道功能恢复前出院；这些患者均未再入院。20例患者（25%）出现并发症，包括伤口感染（8%）、小肠梗阻/肠梗阻（6%）、肠皮肤瘘（1%）、吻合口漏（1%）和晚期腹壁脓肿（1%）。在这些患者中，16%尽管没有术后并发症，但住院时间超过了5天。
在我们机构接受袢式回肠造口还纳术的大多数患者可以比目前更早出院。建议社区提供支持并实施改良的英国日间手术方案，以帮助缩短患者的住院时间。
