Kameyama Hitoshi, Hashimoto Yoshifumi, Shimada Yoshifumi, Yamada Saki, Yagi Ryoma, Tajima Yosuke, Okamura Takuma, Nakano Masato, Miura Kohei, Nagahashi Masayuki, Sakata Jun, Kobayashi Takashi, Kosugi Shin-Ichi, Wakai Toshifumi
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Department of Digestive and General Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.
Ann Coloproctol. 2018 Apr;34(2):94-100. doi: 10.3393/ac.2017.06.14. Epub 2018 Apr 30.
Small bowel obstruction (SBO) remains a common complication after pelvic or abdominal surgery. However, the risk factors for SBO in ulcerative colitis (UC) surgery are not well known. The aim of the present study was to clarify the risk factors associated with SBO after ileal pouch-anal anastomosis (IPAA) with a loop ileostomy for patients with UC.
The medical records of 96 patients who underwent IPAA for UC between 1999 and 2011 were reviewed. SBO was confirmed based on the presence of clinical symptoms and radiographic findings. The patients were divided into 2 groups: the SBO group and the non-SBO group. We also analyzed the relationship between SBO and computed tomography (CT) scan image parameters.
The study included 49 male and 47 female patients. The median age was 35.5 years (range, 14-72 years). We performed a 2- or 3-stage procedure as a total proctocolectomy and IPAA for patients with UC. SBO in the pretakedown of the loop ileostomy after IPAA occurred in 22 patients (22.9%). Moreover, surgical intervention for SBO was required for 11 patients. In brief, closure of the loop ileostomy was performed earlier than expected. A multivariate logistic regression analysis revealed that the 2-stage procedure (odds ratio, 2.850; 95% confidence interval, 1.009-8.044; P = 0.048) was a significant independent risk factor associated with SBO. CT scan image parameters were not significant risk factors of SBO.
The present study suggests that a 2-stage procedure is a significant risk factor associated with SBO after IPAA in patients with UC.
小肠梗阻（SBO）仍是盆腔或腹部手术后常见的并发症。然而，溃疡性结肠炎（UC）手术中SBO的危险因素尚不明确。本研究的目的是明确UC患者行回肠储袋肛管吻合术（IPAA）并带袢回肠造口术后与SBO相关的危险因素。
回顾了1999年至2011年间96例行IPAA治疗UC患者的病历。根据临床症状和影像学检查结果确诊SBO。将患者分为两组：SBO组和非SBO组。我们还分析了SBO与计算机断层扫描（CT）图像参数之间的关系。
该研究包括49例男性和47例女性患者。中位年龄为35.5岁（范围14 - 72岁）。我们对UC患者行全直肠结肠切除术和IPAA采用两阶段或三阶段手术。IPAA术后袢式回肠造口拆除前发生SBO的患者有22例（22.9%）。此外，11例患者需要对SBO进行手术干预。简而言之，袢式回肠造口的关闭比预期提前。多因素logistic回归分析显示，两阶段手术（比值比，2.850；95%置信区间，1.009 - 8.044；P = 0.048）是与SBO相关的显著独立危险因素。CT图像参数不是SBO的显著危险因素。
本研究表明，两阶段手术是UC患者IPAA术后与SBO相关的显著危险因素。
