Colon and Rectal Surgery Program, Division of Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
Dis Colon Rectum. 2012 Jan;55(1):10-7. doi: 10.1097/DCR.0b013e31823907a9.
Bowel function following surgery for diverticulitis has not previously been systematically described.
This study aimed to document the frequency, severity, and predictors of suboptimal bowel function in patients who have undergone sigmoid colectomy for diverticulitis.
This study is a retrospective analysis.
This study was conducted at a large, academic medical center.
Three hundred twenty-five patients who underwent laparoscopic or open sigmoid colectomy with restoration of intestinal continuity for diverticulitis were included in the study population. Of these, 249 patients (76.6%) returned a 70-question survey incorporating the Fecal Incontinence Severity Index, the Fecal Incontinence Quality of Life Scale, and the Memorial Bowel Function Instrument.
Survey responders and nonresponders were compared with the use of χ and t tests. Responders with suboptimal bowel function (fecal incontinence, urgency and/or incomplete emptying) were then compared with those with good outcomes by the use of logistic regression analysis to determine the predictors of poor function.
Of the responders, 24.8% reported clinically relevant fecal incontinence (Fecal Incontinence Severity Index ≥ 24), 19.6% reported fecal urgency (Memorial Bowel Function Instrument Urgency Subscale ≥ 4), and 20.8% reported incomplete emptying (Memorial Bowel Function Instrument Emptying Subscale ≥ 4). On logistic regression analysis, fecal incontinence was predicted by female sex (OR = 2.3, p = 0.008) and the presence of a preoperative abscess (OR = 1.4, p < 0.05). Fecal urgency was associated with female sex (OR = 1.3, p < 0.05) and a diverting ileostomy (OR = 2.1, p < 0.001). Incomplete emptying was associated with female sex (OR = 1.4, p < 0.05) and postoperative sepsis (OR = 1.9, p < 0.05).
This study was limited by the fact that we did not use a nondiverticulitis control group and we had limited preoperative data on the history of bowel impairment symptoms.
One-fifth of patients reported fecal urgency, fecal incontinence, or incomplete emptying after surgery for diverticulitis. Despite the limitations of our study, these results are concerning and should be investigated further prospectively.
此前尚未系统描述过憩室炎手术后的肠道功能。
本研究旨在记录接受憩室炎乙状结肠切除术患者的肠道功能不良的频率、严重程度和预测因素。
本研究为回顾性分析。
本研究在一家大型学术医疗中心进行。
325 例接受腹腔镜或开放性乙状结肠切除术并恢复肠道连续性治疗憩室炎的患者被纳入研究人群。其中，249 例（76.6%）患者返回了包含粪便失禁严重程度指数、粪便失禁生活质量量表和纪念肠道功能仪器的 70 个问题的调查问卷。
采用 χ² 和 t 检验比较调查应答者和非应答者。采用 logistic 回归分析比较有肠道功能不良（粪便失禁、急迫和/或排空不完全）的应答者与有良好结局的应答者，以确定功能不良的预测因素。
在应答者中，24.8%报告有临床相关的粪便失禁（粪便失禁严重程度指数≥24），19.6%报告有粪便急迫感（纪念肠道功能仪器急迫感亚量表≥4），20.8%报告有排空不完全（纪念肠道功能仪器排空亚量表≥4）。logistic 回归分析显示，女性（比值比=2.3，p=0.008）和术前脓肿（比值比=1.4，p<0.05）与粪便失禁相关。粪便急迫感与女性（比值比=1.3，p<0.05）和预防性回肠造口术（比值比=2.1，p<0.001）相关。排空不完全与女性（比值比=1.4，p<0.05）和术后脓毒症（比值比=1.9，p<0.05）相关。
本研究的局限性在于我们没有使用非憩室炎对照组，并且我们对术前肠道损伤症状的病史数据有限。
五分之一的患者在憩室炎手术后报告有粪便急迫感、粪便失禁或排空不完全。尽管我们的研究存在局限性，但这些结果令人担忧，应进一步前瞻性研究。
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