Sparks Eric A, Velazco Cristine S, Fullerton Brenna S, Fisher Jeremy G, Khan Faraz A, Hall Amber M, Jaksic Tom, Rodriguez Leonel, Modi Biren P
Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA, USA.
Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Gastroenterol Res Pract. 2017;2017:7182429. doi: 10.1155/2017/7182429. Epub 2017 Sep 18.
A relationship between intestinal motility and ileostomy prolapse has been suggested but not demonstrated objectively.
This study evaluated the association between ileostomy prolapse and intestinal dysmotility in children.
IRB-approved retrospective review of 163 patients with ileostomies (1998-2014) at a single institution. Patients were categorized as having clinical dysmotility as a primary diagnosis ( = 33), clinically suspected dysmotility based on underlying diagnosis ( = 60), or intestinal dysmotility unlikely ( = 70) at the time of ileostomy present. Intestinal manometry was categorized as normal ( = 13) or abnormal ( = 10). Primary outcome was pathologic stoma prolapse. Multivariate analysis using a logistic regression model and log-rank test to compare stoma prolapse rates over time between motility groups were used.
Clinical diagnosis of dysmotility ( ≤ 0.001) and manometric findings of dysmotility ( = 0.024) were independently associated with stoma prolapse. Clinical dysmotility correlated with manometric findings ( = 0.53). Prolapse occurred in 42% of patients with dysmotility, 34% of patients with suspected dysmotility, and 24% of patients with normal motility. One-year prolapse-free stoma "survival" was 45% for dysmotility, 72% for suspected dysmotility, and 85% for intestinal dysmotility unlikely groups ( = 0.006).
Children with intestinal dysmotility are at great risk for stoma prolapse. Intestinal manometry could help identify these patients preoperatively.
已有研究提出肠道动力与回肠造口脱垂之间存在关联，但尚未得到客观证实。
本研究评估儿童回肠造口脱垂与肠道动力障碍之间的关联。
对一家机构163例回肠造口患者（1998 - 2014年）进行经机构审查委员会批准的回顾性研究。患者分为以临床动力障碍为主要诊断的患者（n = 33）、基于基础诊断临床怀疑有动力障碍的患者（n = 60）或回肠造口时肠道动力障碍可能性不大的患者（n = 70）。肠道测压分为正常（n = 13）或异常（n = 10）。主要结局是病理性造口脱垂。采用逻辑回归模型进行多变量分析，并使用对数秩检验比较动力障碍组之间随时间的造口脱垂率。
动力障碍的临床诊断（P≤0.001）和动力障碍的测压结果（P = 0.024）与造口脱垂独立相关。临床动力障碍与测压结果相关（P = 0.53）。动力障碍患者中42%发生脱垂，疑似动力障碍患者中34%发生脱垂，动力正常患者中24%发生脱垂。动力障碍组1年无脱垂造口“存活率”为45%，疑似动力障碍组为72%，肠道动力障碍可能性不大组为85%（P = 0.006）。
肠道动力障碍的儿童发生造口脱垂的风险很高。肠道测压有助于在术前识别这些患者。
