Uchino M, Ikeuchi H, Bando T, Sasaki H, Chohno T, Horio Y, Takesue Y
Department of Inflammatory Bowel Disease, Hyogo College of Medicine , Hyogo , Japan.
Division of Infection Control and Prevention, Hyogo College of Medicine , Hyogo , Japan.
Ann R Coll Surg Engl. 2018 Mar;100(3):190-193. doi: 10.1308/rcsann.2017.0186. Epub 2017 Oct 19.
Introduction Fistula formation around the ostomy site is a stoma-related complication often requiring surgical intervention. This complication may be caused by sutures or may develop as a complication of inflammatory bowel disease. Before conducting a clinical trial, we set out to investigate the safety of ostomy creation with fewer sutures using tissue adhesives in this pilot study. Methods Patients with inflammatory bowel disease who required surgery with ostomy creation at the Hyogo College of Medicine between January 2014 and December 2015 were enrolled. Safety was assessed by evaluating the incidence of stoma-related complications. Ostomy was restricted to loop ileostomy and was created with two sutures and tissue adhesives. Results A total of 14 patients were enrolled. Mean body mass index was 18.9 ± 2.0 kg/m. There were no cases of ostomy retraction and no severe adverse events were observed. Conclusions This pilot study demonstrates that ostomy creation using tissue adhesives is safe. Although retraction and adverse events were not observed, even in patients with inflammatory bowel disease who generally exhibit delayed wound healing, the body mass index was extremely low in this series. This study does not strongly recommend ostomy creation with tissue adhesives; further studies are needed to clarify the efficacy and safety of the procedure.
引言 造口部位周围瘘管形成是一种与造口相关的并发症,常需手术干预。这种并发症可能由缝合引起,也可能作为炎症性肠病的并发症而出现。在开展一项临床试验之前,我们在这项前瞻性研究中着手调查使用组织粘合剂减少缝合进行造口术的安全性。方法 纳入2014年1月至2015年12月期间在兵库医科大学需要进行造口术的炎症性肠病患者。通过评估与造口相关并发症的发生率来评估安全性。造口仅限于袢式回肠造口术,采用两根缝线和组织粘合剂进行造口。结果 共纳入14例患者。平均体重指数为18.9±2.0kg/m²。未发生造口回缩病例,未观察到严重不良事件。结论 这项前瞻性研究表明,使用组织粘合剂进行造口术是安全的。虽然未观察到回缩和不良事件,即使在通常伤口愈合延迟的炎症性肠病患者中也是如此,但本系列患者的体重指数极低。本研究并不强烈推荐使用组织粘合剂进行造口术;需要进一步研究以阐明该手术的疗效和安全性。