Division of Surgery, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
Colorectal Dis. 2012 Feb;14(2):188-93. doi: 10.1111/j.1463-1318.2011.02578.x.
The aim of this retrospective study of ileocolonic resection in patients with Crohn's disease was to compare the outcome of primary anastomosis with that of split stoma and delayed anastomosis in a high-risk setting.
From 1995 to 2006, 132 patients had 146 operations for ileocolonic Crohn's disease. Preoperative data, including risk factors for complications, were obtained from a prospectively registered database. Operations on patients who had two or more preoperative risk factors (n = 76) were considered to be high-risk operations and formed the main study. Primary outcome variables were postoperative anastomotic complications and the alteration in the number of preoperative risk factors achieved by a delayed anastomosis. Secondary outcome was time in hospital and the number of operations performed.
Early anastomotic complications were diagnosed in 19% (11/57) of patients receiving a primary anastomosis compared with 0% (0/19) of patients after a delayed anastomosis (P = 0.038). The mean number of risk factors in the split stoma group was 3.5 at the time of resection and 0.2 when the split stoma was reversed (P < 0.0001). The total number of operations was 1.9 ± 1.5 (mean ± SD) after a primary anastomosis and 2.0 ± 0.2 after a split stoma (P = 0.70). Total in-hospital time for all operations was 20.9 ± 35.6 days after a primary anastomosis and 17.8 ± 10.4 days after a delayed anastomosis (P = 0.74).
Delayed anastomosis after ileocolonic resection in high-risk Crohn's disease patients was associated with a reduction in the number of preoperative risk factors and fewer anastomotic complications. Hospital stay and number of operations were similar after delayed and primary anastomosis in high-risk patients.
本回顾性研究旨在比较克罗恩病患者行回结肠切除术时行一期吻合、结肠造口和延期吻合的效果，该研究对象为高危患者。
1995 年至 2006 年，共有 132 例克罗恩病患者接受了 146 次回结肠手术。从前瞻性登记的数据库中获取包括并发症相关风险因素在内的术前数据。如果患者存在 2 个或以上术前风险因素（n=76），则将该手术视为高危手术，作为主要研究对象。主要研究终点为术后吻合口并发症和延期吻合口对术前风险因素数量的改变。次要终点为住院时间和手术次数。
行一期吻合术的患者中，19%（11/57）出现早期吻合口并发症，而行延期吻合术的患者无一例发生吻合口并发症（P=0.038）。结肠造口组患者在手术时的平均风险因素数量为 3.5，而在结肠造口还纳时降为 0.2（P<0.0001）。行一期吻合术的患者平均手术次数为 1.9±1.5 次，而行结肠造口的患者为 2.0±0.2 次（P=0.70）。所有手术的总住院时间在一期吻合术患者中为 20.9±35.6 天，在延期吻合术患者中为 17.8±10.4 天（P=0.74）。
在高危克罗恩病患者中，行回结肠切除术后行延期吻合可减少术前风险因素的数量，并降低吻合口并发症的发生率。在高危患者中，延期吻合术和一期吻合术的住院时间和手术次数相似。
