Piessen Guillaume, Muscari Fabrice, Rivkine Emmanuel, Sbaï-Idrissi Mohamed Saïd, Lorimier Gérard, Fingerhut Abe, Dziri Chadli, Hay Jean-Marie
Department of General and Digestive Surgery, Hôpital Huriez, Centre Hospitalier Universitaire, Lille, France.
Arch Surg. 2011 Oct;146(10):1149-55. doi: 10.1001/archsurg.2011.231.
Independent risk factors for postoperative morbidity after colectomy are most likely linked to disease characteristics.
Retrospective analysis.
Twenty-eight centers of the French Federation for Surgical Research.
In total, 1721 patients (1230 with colon cancer [CC] and 491 with diverticular disease [DD]) from a databank of 7 prospective, multisite, randomized trials on colorectal resection.
Elective left colectomy via laparotomy.
Preoperative and intraoperative risk factors for postoperative morbidity.
Overall postoperative morbidity was higher in CC than in DD (32.4% vs 30.3%) but the difference was not statistically significant (P = .40). Two independent risk factors for morbidity in CC were antecedent heart failure (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.42-6.32) (P = .003) and bothersome intraluminal fecal matter (2.08; 1.42-3.06) (P = .001). Three independent risk factors for morbidity in DD were at least 10% weight loss (OR, 2.06; 95% CI, 1.25-3.40) (P = .004), body mass index (calculated as weight in kilograms divided by height in meters squared) exceeding 30 (2.05; 1.15-3.66) (P = .02), and left hemicolectomy (vs left segmental colectomy) (2.01; 1.19-3.40) (P = .009).
Patients undergoing elective left colectomy for CC or for DD constitute 2 distinct populations with completely different risk factors for morbidity, which should be addressed differently. Improving colonic cleanliness (by antiseptic enema) may reduce morbidity in CC. In DD, morbidity may be reduced by appropriate preoperative nutritive support (by immunonutrition), even in patients with obesity, and by preference of left segmental colectomy over left hemicolectomy. By decreasing morbidity, mortality should be lowered as well, especially when reoperation becomes necessary.
结肠切除术后发病的独立危险因素极有可能与疾病特征相关。
回顾性分析。
法国外科研究联合会的28个中心。
来自7项关于结直肠切除的前瞻性、多中心、随机试验数据库的1721例患者（1230例结肠癌[CC]患者和491例憩室病[DD]患者）。
经剖腹术行择期左半结肠切除术。
术后发病的术前及术中危险因素。
CC患者的总体术后发病率高于DD患者（32.4%对30.3%），但差异无统计学意义（P = 0.40）。CC患者发病的两个独立危险因素为既往心力衰竭（比值比[OR]，3.00；95%置信区间[CI]，1.42 - 6.32）（P = 0.003）和腔内粪便过多（2.08；1.42 - 3.06）（P = 0.001）。DD患者发病的三个独立危险因素为体重减轻至少10%（OR，2.06；95%CI，1.25 - 3.40）（P = 0.004）、体重指数（按千克体重除以身高米的平方计算）超过30（2.05；1.15 - 3.66）（P = 0.02）以及左半结肠切除术（与左节段结肠切除术相比）（2.01；1.19 - 3.40）（P = 0.009）。
因CC或DD接受择期左半结肠切除术的患者构成两个不同的群体，其发病危险因素完全不同，应区别对待。改善结肠清洁度（通过抗菌灌肠）可能降低CC患者的发病率。在DD患者中，即使是肥胖患者，适当的术前营养支持（通过免疫营养）以及优先选择左节段结肠切除术而非左半结肠切除术可能降低发病率。通过降低发病率，死亡率也应降低，尤其是在需要再次手术时。
