直肠结肠切除术（保肛术）后永久性回肠造口的预测因素。

Predictors of permanent ileostomy after restorative proctocolectomy.

机构信息

Department of General, Visceral, Vascular and Thoracic Surgery, Charité, Campus Benjamin Franklin, Berlin, Germany.

出版信息

Br J Surg. 2010 Oct;97(10):1561-6. doi: 10.1002/bjs.7135.

DOI:10.1002/bjs.7135

PMID:20632324

Abstract

BACKGROUND

Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a surgical approach for ulcerative colitis and familial adenomatous polyposis. This study evaluated predictors of the need for a permanent ileostomy to identify patients at high risk of IPAA failure.

METHODS

This was a retrospective analysis of patients who underwent proctocolectomy and IPAA between 1997 and 2008. A logistic regression model was used for multivariable analysis of potential risk factors.

RESULTS

Proctocolectomy was combined with IPAA in 185 patients, of whom 169 had a loop ileostomy formed. IPAA and ileostomy closure were successful in 162 patients (87.6 per cent). Reasons for not closing the ileostomy included pouch failure (16 patients), patient choice (5) and death (2). Thus one in eight patients had a permanent ileostomy after planned IPAA. Age was the major predictor of the need for a permanent ileostomy in multivariable analysis (P = 0.002) with a probability of more than 25 per cent in patients aged over 60 years. However, advancing age was associated with colitis, co-morbidity, obesity and corticosteroid use.

CONCLUSION

The probability of the need for a permanent ileostomy after IPAA increases with age.

摘要

背景

直肠结肠切除术联合回肠储袋肛管吻合术（IPAA）是一种用于治疗溃疡性结肠炎和家族性腺瘤性息肉病的手术方法。本研究评估了永久性回肠造口术需求的预测因素，以确定 IPAA 失败的高危患者。

方法

这是一项对 1997 年至 2008 年间接受直肠结肠切除术和 IPAA 治疗的患者进行的回顾性分析。采用逻辑回归模型对潜在风险因素进行多变量分析。

结果

185 例患者接受了直肠结肠切除术联合 IPAA 治疗，其中 169 例形成了环型回肠造口。162 例患者成功进行了 IPAA 和回肠造口关闭（87.6%）。未关闭回肠造口的原因包括储袋失败（16 例）、患者选择（5 例）和死亡（2 例）。因此，计划进行 IPAA 后，有 1/8 的患者需要永久性回肠造口。多变量分析显示，年龄是永久性回肠造口需求的主要预测因素（P = 0.002），年龄超过 60 岁的患者发生永久性回肠造口的概率超过 25%。然而，年龄的增长与结肠炎、合并症、肥胖和皮质类固醇的使用有关。