Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
Colorectal Dis. 2011 May;13(5):555-60. doi: 10.1111/j.1463-1318.2010.02186.x.
We evaluated the impact of immunosuppressive drugs on the short-term outcome following loop ileostomy closure in patients with inflammatory bowel disease.
Data on 249 patients with inflammatory bowel disease, who underwent loop ileostomy closure from 2001 to 2008, were retrospectively reviewed from a prospectively maintained database. Patients were distributed among groups according to the inflammatory bowel disease drugs used. Comorbidity, diagnosis, intra-operative and postoperative morbidity and length of stay data were analysed. Patients in group (INF) were receiving infliximab with or without other immunosuppressive agents (28), patients in group (S) were receiving only steroids (72) and those, in group III (S&I) were on steroids plus immunosuppressive agents, other than infliximab (35). Patients in group (ND) had not received any immunosuppressive agents for 2 months and served as the control group (114).
Postoperative complication rates (wound infection, hernia, obstruction, intra-abdominal abscess, leakage, enterocutaneous fistula and sepsis) occured in 4.0, 12.0, 14 and 17.0% of patients in the four groups (P > 0.05). Reoperation was needed in 3.0% (2) of patients in group S, 6.0% (2) in S&I and 3.0% (3) in C groups, and the mean hospital stay was 4.6 (± 2.1), 5.6 (± 4.6), 5.2 (± 4.7) and 5.2 (± 6) days in groups INF, S, S&I and ND, respectively. There was no mortality.
There were no significantly increased postoperative complications after ileostomy closure in patients who received infliximab or other immunosuppressive medications compared with patients who did not.
评估免疫抑制剂药物对炎症性肠病患者行回肠袢式造口还纳术后近期结局的影响。
回顾性分析 2001 年至 2008 年间 249 例行回肠袢式造口还纳术的炎症性肠病患者的临床资料,该研究数据来自前瞻性维护的数据库。根据患者接受的炎症性肠病药物,将患者分为以下几组:INF 组(28 例,接受英夫利昔单抗联合或不联合其他免疫抑制剂)、S 组(72 例,仅接受皮质类固醇激素)、S&I 组(35 例,接受皮质类固醇激素联合除英夫利昔单抗以外的免疫抑制剂)和 ND 组(114 例,2 个月内未接受任何免疫抑制剂治疗)。分析各组患者的合并症、诊断、术中及术后并发症发病率和住院时间。
4 组患者的术后并发症发生率(切口感染、疝、梗阻、腹腔脓肿、肠漏、肠皮肤瘘和脓毒症)分别为 4.0%、12.0%、14.0%和 17.0%(P > 0.05)。S 组、S&I 组和 ND 组分别有 3.0%(2 例)、6.0%(2 例)和 3.0%(3 例)需要再次手术,S 组、S&I 组和 ND 组的平均住院时间分别为 5.6(± 4.6)、5.2(± 4.7)和 5.2(± 6)天。所有患者均未出现死亡。
与未接受免疫抑制剂治疗的患者相比,接受英夫利昔单抗或其他免疫抑制剂治疗的患者行回肠袢式造口还纳术后,其术后并发症无显著增加。