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开腹处理后造口的还纳

The Reversal of Stoma Following Open Abdomen Management.

作者信息

Yetişir Fahri, Şarer AkgünEbru, Acar H Zafer, Çiftciler Erdinç

机构信息

General Surgery Department, Atatürk Research and Training Hospital, Ankara, Turkey.

Anesthesiology and Reanimation Department, Research and Training Hospital, Ankara, Turkey.

出版信息

Indian J Surg. 2016 Jun;78(3):182-6. doi: 10.1007/s12262-015-1336-2. Epub 2015 Sep 5.

Abstract

Bowel stoma formation is very often required during open abdomen (OA) management; we aim to report our stoma reversal series following OA management retrospectively. A retrospective analysis of 31 patients who underwent the reversal of the stoma created during OA management between January 2008 and September 2014 was performed. Twenty-eight of these 31 patients were included in this study. The stoma-related complications are more common after OA management during waiting time interval for reversal. At this time interval, patients with jejunostomy had more stoma-related complications than patients with ileostomy (p = 0.008) and colostomy. (p = 0.001). Waiting time interval was shorter for reversal of jejunostomy than reversal of ileostomy (p = 0.014) and colostomy (p = 0.001). Operation time for jejunostomy (p = 0.016) and colostomy reversal (p = 0.001) were significantly longer than the ileostomy reversal. There was no difference between early and late reversal of stoma regarding morbidity and mortality. The stoma-related complications are more common following OA management during waiting time interval for stoma reversal. The reversal time is more critical for this kind of patients especially with life-threatening complicated jejunostomy. For loop stoma created during OA management, the reversal may be performed after average 50 days without increasing morbidity and mortality. The reversal of end stoma created during OA management has high morbidity. If it is possible, loop stoma should be preferred during OA management.

摘要

在开放性腹部(OA)处理过程中,肠造口术的实施非常常见;我们旨在回顾性报告OA处理后我们的造口回纳系列情况。对2008年1月至2014年9月期间在OA处理期间造口并接受回纳的31例患者进行了回顾性分析。这31例患者中有28例纳入本研究。在等待回纳的时间间隔内,造口相关并发症在OA处理后更为常见。在此时间间隔内,空肠造口患者比回肠造口患者(p = 0.008)和结肠造口患者有更多的造口相关并发症(p = 0.001)。空肠造口回纳的等待时间间隔比回肠造口回纳(p = 0.014)和结肠造口回纳(p = 0.001)短。空肠造口(p = 0.016)和结肠造口回纳(p = 0.001)的手术时间明显长于回肠造口回纳。造口早期和晚期回纳在发病率和死亡率方面没有差异。在等待造口回纳的时间间隔内,OA处理后造口相关并发症更为常见。回纳时间对这类患者尤其是伴有危及生命的复杂空肠造口患者更为关键。对于OA处理期间创建的袢式造口,平均50天后可进行回纳,且不增加发病率和死亡率。OA处理期间创建的端式造口回纳有较高的发病率。如果可能,OA处理期间应首选袢式造口。

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