Guo Zhen, Guo Dong, Gong Jianfeng, Zhu Weiming, Zuo Lugen, Sun Jing, Li Ning, Li Jieshou
Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, China.
Gastroenterol Res Pract. 2016;2016:5017856. doi: 10.1155/2016/5017856. Epub 2015 Dec 27.
Background. The rate of anastomotic leakage is high in surgeries for Crohn's disease, and therefore a temporary diverting stoma is often needed. We conducted this study to investigate whether preoperative nutritional therapy could reduce the risk of anastomotic leakage while decreasing the frequency of temporary stoma formation. Methods. This was a retrospective study. Patients requiring bowel resections due to Crohn's disease were reviewed. The rate of anastomotic leakage and temporary diverting stoma was compared between patients who received preoperative nutritional therapy and those on a normal diet before surgery. Possible predictive factors for anastomotic leakage were also analyzed. Results. One hundred and fourteen patients undergoing 123 surgeries were included. Patients in nutritional therapy (NT) group had a significantly lower level of C-reactive protein on the day before surgery. Patients in NT group suffered less anastomotic leakage (2.3% versus 17.9%, P = 0.023) and less temporary diverting stoma (22.8% versus 40.9%, P = 0.036). Serum albumin of the day before surgery ≤35 g/L and preoperative nutritional therapy were identified as factors which independently affected the rate of anastomotic leakage. Conclusion. Preoperative nutritional therapy reduced the risk of anastomotic leakage and the frequency of temporary diverting stoma formation in patients with Crohn's disease requiring resections.
背景。克罗恩病手术中吻合口漏的发生率较高,因此常需要做临时转流造口术。我们开展这项研究以调查术前营养治疗是否能降低吻合口漏风险,同时减少临时造口形成的频率。方法。这是一项回顾性研究。对因克罗恩病需要行肠切除术的患者进行了评估。比较了接受术前营养治疗的患者与术前接受正常饮食的患者的吻合口漏发生率和临时转流造口率。还分析了吻合口漏可能的预测因素。结果。纳入了114例接受123次手术的患者。营养治疗(NT)组患者术前一天的C反应蛋白水平显著较低。NT组患者发生吻合口漏的情况较少(2.3%对17.9%,P = 0.023),且临时转流造口较少(22.8%对40.9%,P = 0.036)。术前一天血清白蛋白≤35 g/L和术前营养治疗被确定为独立影响吻合口漏发生率的因素。结论。术前营养治疗降低了需要行切除术的克罗恩病患者的吻合口漏风险和临时转流造口形成的频率。