Gorgun Emre, Sapci Ipek, Onder Akin, Ozuner Gokhan, Liska David, Stocchi Luca, Delaney Conor P
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
Am J Surg. 2018 Jan;215(1):62-65. doi: 10.1016/j.amjsurg.2017.10.002. Epub 2017 Oct 6.
Porto-mesenteric venous thrombosis (PMVT) is an uncommon but serious complication. Data on the risk factors for PMVT following total colectomy with ileorectal anastomosis or end ileostomy (TC/IRA or EI) is limited. This study aimed to evaluate the factors associated with PMVT after TC/IRA or EI.
Patients who underwent elective TC/IRA or EI between January 2010 and December 2014 were identified from institutional database. Patients who had CT proven PMVT within 30 days of surgery were included in the PMVT positive group. Demographics and perioperative/postoperative 30-day outcomes were compared between groups.
Out of 832 patients, 34 patients (4.1%) were diagnosed with PMVT. PMVT positive group were younger (35.8vs.41 years, p = 0.03). Postoperative organ-space surgical site infection (17.6% vs. 4.8%, p = 0.007), deep venous thrombosis (8.8%vs.1.5%, p = 0.02), ileus (38.2%vs.20.8%, p = 0.018), and readmission (50.0%vs.12.7%, p < 0.001) were more common in patients with PMVT, who also had longer hospital stay (8.5vs.6 days, p = 0.002).
PMVT after TC/IRA or EI may occur in non-IBD patients. PMVT should be included in differential diagnosis after TC/IRA or EI in patients with intraabdominal infection or ileus, especially in younger patients.
门静脉肠系膜静脉血栓形成（PMVT）是一种罕见但严重的并发症。关于全结肠切除回直肠吻合术或末端回肠造口术（TC/IRA或EI）后发生PMVT的危险因素的数据有限。本研究旨在评估TC/IRA或EI术后与PMVT相关的因素。
从机构数据库中识别出2010年1月至2014年12月期间接受择期TC/IRA或EI的患者。手术30天内CT证实为PMVT的患者纳入PMVT阳性组。比较两组的人口统计学和围手术期/术后30天的结局。
在832例患者中，34例（4.1%）被诊断为PMVT。PMVT阳性组患者更年轻（35.8岁对41岁，p = 0.03）。PMVT患者术后器官腔隙手术部位感染（17.6%对4.8%，p = 0.007）、深静脉血栓形成（8.8%对1.5%，p = 0.02）、肠梗阻（38.2%对20.8%）和再入院（50.0%对12.7%，p < 0.001）更为常见，住院时间也更长（8.5天对6天，p = 0.002）。
TC/IRA或EI术后PMVT可能发生在非炎症性肠病患者中。对于腹部感染或肠梗阻患者，尤其是年轻患者，在TC/IRA或EI术后的鉴别诊断中应考虑PMVT。
