Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Inflamm Bowel Dis. 2013 Sep;19(10):2173-81. doi: 10.1097/MIB.0b013e31829bfc26.
The aim was to evaluate the impact of weight gain on pouch outcomes after ileostomy closure.
Consecutive inflammatory bowel disease patients with ileal pouches followed up at our subspecialty Pouch Center from 2002 to 2011 were studied. The association of excessive weight gain (defined as a 15% increase the index weight) with pouch outcomes were evaluated using univariate and multivariate analyses.
A total of 846 patients met inclusion criteria, with 470 (55.6%) being men. The mean age at the diagnosis of inflammatory bowel disease and at pouch surgery was 27.2 ± 11.9 years and 37.8 ± 12.8 years, respectively. Patients with weight gain more likely had mechanical or surgical complications of the pouch (18.4% versus 12.3%, P = 0.049), Crohn's disease of the pouch (30.6% versus 18.5%, P = 0.001), Pouch Center visits (2.0 [1.0-4.0] versus 2.0 [1.0-3.0], P = 0.008), and postoperative pouch-related hospitalization (21.1% versus 10.6%, P < 0.001). After a median follow-up of 9.0 (interquartile range = 4.0-14.0) years, 68 patients (8.0%) developed pouch failure. In the multivariate analysis, excessive weight gain was an independent risk factor for pouch failure with a hazard ratio of 1.69 (95% confidence interval = 1.01-2.84, P = 0.048) after adjusting for preoperative or postoperative use of anti-tumor necrosis factor biologics, postoperative use of immunosuppressants, Crohn's disease of the pouch, mechanical or surgical complications of the pouch, and postoperative pouch-associated hospitalization.
Excessive weight gain after closure of the ileostomy is associated with worse pouch outcomes in patients with inflammatory bowel disease. Appropriate weight control may help improve pouch retention.
本研究旨在评估肠造口关闭后体重增加对 pouch 结局的影响。
回顾性分析 2002 年至 2011 年在我们的 pouch 中心接受随访的炎症性肠病患者。使用单因素和多因素分析评估体重过度增加（定义为体重指数增加 15%）与 pouch 结局的关系。
共有 846 例患者符合纳入标准，其中 470 例（55.6%）为男性。炎症性肠病的诊断和 pouch 手术年龄分别为 27.2±11.9 岁和 37.8±12.8 岁。与体重增加相关的患者更容易出现 pouch 的机械或手术并发症（18.4%比 12.3%，P=0.049）、 pouch 克罗恩病（30.6%比 18.5%，P=0.001）、 pouch 中心就诊次数（2.0[1.0-4.0]比 2.0[1.0-3.0]，P=0.008）和术后 pouch 相关住院（21.1%比 10.6%，P＜0.001）。中位随访 9.0 年（四分位距 4.0-14.0 年）后，68 例（8.0%）患者 pouch 失功。多因素分析显示，在校正术前或术后使用抗肿瘤坏死因子生物制剂、术后使用免疫抑制剂、 pouch 克罗恩病、 pouch 的机械或手术并发症以及术后与 pouch 相关的住院治疗后，体重过度增加是 pouch 失功的独立危险因素，风险比为 1.69（95%置信区间 1.01-2.84，P=0.048）。
肠造口关闭后体重过度增加与炎症性肠病患者 pouch 结局较差有关。适当的体重控制可能有助于改善 pouch 的保留率。
