Matikainen M, Santavirta J, Hiltunen K M
Department of Surgery, University Central Hospital of Tampere, Finland.
Dis Colon Rectum. 1990 May;33(5):384-8. doi: 10.1007/BF02156263.
Ileoanal anastomosis is usually performed with covering ileostomy. This is primarily done because of fear of pelvic sepsis. Temporary ileostomy may, however, be a source of significant complications. The first 21 patients in the authors clinic were operated upon using covering loop ileostomy in ileoanal operations. These patients had no anastomotic or pouch complications, but there were complications, especially with the closure of the ileostomy. Therefore, a trial of one-stage operations in ileoanal anastomosis was started. Ileoanal anastomosis without ileostomy was performed on 25 consecutive patients. All the patients were operated upon for ulcerative colitis. There was one patient with pelvic abscess who needed diverting ileostomy. Thus, the early failure rate in patients operated upon without ileostomy was 4 percent. There were many other complications among these patients, but no other relaparotomy was needed. The complication rate was not different in patients operated upon without ileostomy compared with the authors first 21 patients operated upon with ileostomy (60 and 52 percent, respectively). Patients with one-stage operation needed a significantly shorter mean hospital stay than patients with two-stage operation (13.6 days and 25.3 days, respectively; P less than 0.001). The use of corticosteroids appears not to be a contraindication for one-stage operation, because there were significantly more patients using corticosteroids in the one-stage group compared with the two-stage group (92 and 62 percent, respectively; P less than 0.05).
回肠肛管吻合术通常在覆盖回肠造口的情况下进行。这样做主要是出于对盆腔感染的担忧。然而，临时回肠造口可能是严重并发症的一个来源。作者诊所的前21例患者在回肠肛管手术中采用覆盖袢式回肠造口术进行手术。这些患者没有吻合口或贮袋并发症，但存在并发症，尤其是回肠造口关闭时的并发症。因此，开始了回肠肛管吻合术一期手术的试验。对25例连续患者进行了无回肠造口的回肠肛管吻合术。所有患者均因溃疡性结肠炎接受手术。有1例盆腔脓肿患者需要行转流性回肠造口术。因此，无回肠造口手术患者的早期失败率为4%。这些患者中还有许多其他并发症，但无需再次剖腹手术。与作者最初21例行回肠造口术的患者相比，无回肠造口手术患者的并发症发生率没有差异（分别为60%和52%）。一期手术患者的平均住院时间明显短于二期手术患者（分别为13.6天和25.3天；P<0.001）。使用皮质类固醇似乎不是一期手术的禁忌证，因为一期组使用皮质类固醇的患者明显多于二期组（分别为92%和62%；P<0.05）。
