Stewart S, Southwood L L, Aceto H W
Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, USA.
Equine Vet J. 2014 May;46(3):333-8. doi: 10.1111/evj.12143. Epub 2013 Oct 31.
There is disagreement among surgeons over whether jejunoileostomy (JI) or jejunocaecostomy (JC) is the better method of anastomosis following proximal ileal resection.
To compare short- and long-term complications and outcome in horses undergoing jejunojejunostomy (JJ), JI and JC and to test the hypotheses that a higher proportion of horses undergoing JI would have short-term complications and mortality compared with horses undergoing JC or JJ and that JC would be associated with a higher long-term mortality and occurrence of colic.
Retrospective cross-sectional study.
Medical records of horses undergoing celiotomy for a small intestinal obstruction and JJ, JI or JC from 2005 to 2010 were reviewed. Post operative complications were recorded. Short-term outcome was alive vs. dead at hospital discharge and was analysed using a Chi-squared test. Long-term follow-up was obtained and a Kaplan-Meier estimate of the survivor function was performed.
There were 112 horses included. A higher proportion of JI horses had a repeat celiotomy during hospitalisation compared with horses undergoing JC. The number of horses alive at hospital discharge was not different between groups: JJ 79% (95% confidence interval [CI] 68-90%), JI 78% (95% CI 61-96%), JC 83% (95% CI 71-96%). Among horses discharged with long-term follow-up, more horses had colic after JC compared with JJ or JI. Long-term post discharge survival based on the Kaplan-Meier survivor function was lower for horses undergoing JC than JJ or JI (P = 0.04).
While there was no difference in short-term outcome between groups, more horses with JI underwent a repeat celiotomy during hospitalisation. Horses with a JC were more likely to have long-term complications with colic. Horses that were subjected to euthanasia because of colic within 12 months of hospital discharge either had a JC or repeat celiotomy. The results suggest that, when possible, a JI may be the preferred method of anastomosis based on more favourable survival and lower occurrence of colic long term.
外科医生对于空肠回肠吻合术（JI）或空肠盲肠吻合术（JC）是否是近端回肠切除术后更好的吻合方法存在分歧。
比较接受空肠空肠吻合术（JJ）、JI和JC的马匹的短期和长期并发症及预后情况，并检验以下假设：与接受JC或JJ的马匹相比，接受JI的马匹出现短期并发症和死亡的比例更高；JC与更高的长期死亡率和绞痛发生率相关。
回顾性横断面研究。
回顾了2005年至2010年因小肠梗阻接受剖腹术并进行JJ、JI或JC的马匹的病历。记录术后并发症。短期预后为出院时存活与死亡，并使用卡方检验进行分析。获得长期随访结果，并进行Kaplan-Meier生存函数估计。
共纳入112匹马。与接受JC的马匹相比，接受JI的马匹在住院期间再次进行剖腹术的比例更高。各组出院时存活的马匹数量无差异：JJ为79%（95%置信区间[CI]68 - 90%），JI为78%（95%CI 61 - 96%），JC为83%（95%CI 71 - 96%）。在进行长期随访出院的马匹中，与JJ或JI相比，JC后出现绞痛的马匹更多。基于Kaplan-Meier生存函数的出院后长期存活率，接受JC的马匹低于JJ或JI（P = 0.04）。
虽然各组短期预后无差异，但接受JI的马匹在住院期间更多地接受了再次剖腹术。接受JC的马匹更有可能出现长期绞痛并发症。在出院后12个月内因绞痛实施安乐死的马匹要么接受了JC，要么接受了再次剖腹术。结果表明，在可能的情况下，基于更有利的长期存活和更低的绞痛发生率，JI可能是首选的吻合方法。
