Luglio Gaetano, Pendlimari Rajesh, Holubar Stefan D, Cima Robert R, Nelson Heidi
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Arch Surg. 2011 Oct;146(10):1191-6. doi: 10.1001/archsurg.2011.234.
Diverting loop ileostomy is used to mitigate the sequelae of anastomotic dehiscence.
To report the rate of complications after ileostomy reversal using standardized definitions to aid physicians who are deciding whether to divert anastomoses.
Patients who underwent diverting loop ileostomy closure from January 1, 2005, through February 28, 2010, were identified using a prospective database. Perioperative variables and 30-day outcomes were reviewed. Complications were graded according to the Clavien-Dindo Classification, in which grade III, IV, or V represents major complications. Univariate analysis assessed the relationship between operative variables and surgical outcomes.
A total of 944 patients underwent reversal: 43.1% were women, the mean age was 47.2 years, the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 25.7, and 18.5% were American Society of Anesthesiologists class III or IV. Indications for the initial operation were ulcerative colitis (49.5%), rectal cancer (27.5%), diverticular disease (6.8%), and other (16.1%). Anastomotic technique for reversal was sutured fold-over in 466 patients (49.4%), stapled in 315 (33.4%), and handsewn end to end in 163 (17.3%). After reversal, the mean time to first bowel movement, tolerance of soft diet, and discharge from hospital was 2.6, 3.7, and 5.2 days, respectively. Handsewn cases had longer operative times and longer times to bowel movement, soft diet, and discharge. Overall, complications occurred in 203 patients (21.5%), including 45 patients (4.8%) who experienced a major complication; there were no deaths within 30 days.
Ileostomy closure is associated with a low rate of major grade III and IV complications and should be reserved for patients who have a predicted postoperative major complication rate of 5% or more without diversion.
转流性回肠造口术用于减轻吻合口裂开的后遗症。
使用标准化定义报告回肠造口术回纳后的并发症发生率，以帮助决定是否对吻合口进行转流的医生。
通过前瞻性数据库识别2005年1月1日至2010年2月28日期间接受转流性回肠造口术关闭的患者。回顾围手术期变量和30天结局。并发症根据Clavien-Dindo分类进行分级，其中III、IV或V级代表主要并发症。单因素分析评估手术变量与手术结局之间的关系。
共有944例患者接受了回纳：43.1%为女性，平均年龄为47.2岁，平均体重指数（按千克体重除以身高米的平方计算）为25.7，18.5%为美国麻醉医师协会III或IV级。初次手术的指征为溃疡性结肠炎（49.5%）、直肠癌（27.5%）、憩室病（6.8%）和其他（16.1%）。回纳的吻合技术为466例患者（49.4%）采用缝合折叠法，315例（33.4%）采用吻合器吻合，163例（17.3%）采用手工端端吻合。回纳后，首次排便的平均时间、软食耐受时间和出院时间分别为2.6天、3.7天和5.2天。手工缝合病例的手术时间更长，排便、软食耐受和出院时间也更长。总体而言，203例患者（21.5%）发生并发症，包括45例（4.8%）发生主要并发症；30天内无死亡病例。
回肠造口术关闭与III级和IV级主要并发症的发生率较低相关，应保留给预计术后无转流时主要并发症发生率为5%或更高的患者。
