Deltell Colomer P, Albertos Mira-Marcelí N, Gallego Mellado N, Kuan Argüello M E, Bordallo Vázquez M F, Mira Navarro J, Gonzálvez Piñera J
Servicio de Cirugía Pediátrica. Hospital General Universitario de Alicante.
Cir Pediatr. 2015 Apr 15;28(2):55-58.
In more than 50% of the necrotizing enterocolitis that underwent surgery will require an ileostomy. The optimal time to reestablish intestinal transit still is a controversial subject. Many times ileostomies cause medical issues that require early intestinal reconstruction. Our objective is to compare the early closure against late close, being the shift point 35 days according to other published research.
Retrospective study off all patients that in the last 10 years have had an episode of necrotizing enterocolitis which required an intestinal derivation like ileostomy.
We studied 39 patients, 22 had an early closure (EC) and 17 in had a late closure (LC). There were statistically significant differences in age and weight between both groups, being younger in the EC group (p<0,05). All the morbidity factors were greater in the EC group (days of parenteral nutrition, days of central venous catheter, inotropic use, surgical wound infection and intestinal occlusions). The days of mechanical ventilation were greater in the EC group (2,33 vs p=0,017). The rate of reoperation was higher in the EC group (31%) against the LE group (17%).
It is necessary to perform prospective studies with larger number of patients to be able to recommend a late closure ileostomy. In our experience the early closure has more morbidity and a higher rate of surgical reoperations.
超过50%接受手术的坏死性小肠结肠炎患者需要进行回肠造口术。重建肠道传输的最佳时机仍是一个有争议的话题。很多时候，回肠造口术会引发一些需要早期肠道重建的医疗问题。我们的目标是比较早期关闭与晚期关闭，根据其他已发表的研究，转折点为35天。
对过去10年中发生过坏死性小肠结肠炎且需要进行如回肠造口术等肠道转流术的所有患者进行回顾性研究。
我们研究了39例患者，22例进行了早期关闭（EC），17例进行了晚期关闭（LC）。两组在年龄和体重方面存在统计学上的显著差异，EC组患者更年轻（p<0.05）。EC组的所有发病因素都更高（肠外营养天数、中心静脉导管使用天数、使用血管活性药物、手术伤口感染和肠梗阻）。EC组的机械通气天数更多（2.33天对p = 0.017）。EC组的再次手术率（31%）高于晚期关闭组（17%）。
有必要进行更大规模患者的前瞻性研究，以便能够推荐晚期关闭回肠造口术。根据我们的经验，早期关闭会带来更多发病情况和更高的手术再次手术率。
