Ceretti Andrea Pisani, Maroni Nirvana, Longhi Marco, Giovenzana Marco, Santambrogio Roberto, Barabino Matteo, Luigiano Carmelo, Radaelli Giovanni, Opocher Enrico
Department of Surgery II, San Paolo Hospital, University of Milan, Via A di Rudinì 8, I-20142 Milan, Italy.
Department of Endoscopy, San Paolo Hospital, University of Milan, Via A di Rudinì 8, I-20142 Milan, Italy.
Rev Recent Clin Trials. 2018;13(4):295-304. doi: 10.2174/1574887113666180521111153.
Prolonged Postoperative Ileus (PPOI) after abdominal surgery may affect unfavourably the patient recovery. The aim of this study was to estimate the incidence of PPOI in patients elective for colorectal resection and investigate perioperative variables associated with PPOI.
A consecutive series of 428 patients undergoing colorectal resection (median age 72, range 24-92, years; men/women ratio 1.14) were analyzed. Data were extracted retrospectively throughout a five-year period from an electronic prospectively maintained database. PPOI was defined as the need for postoperative insertion of a nasogastric tube in a patient experiencing nausea and two episodes of vomiting and further showing absence of adequate bowel function (absence of flatus/stool) with lack of bowel sounds and abdominal distension.
Incidence of PPOI was 7% [95% confidence interval (95%CI), 4.8-9.9%]. Mean hospital stay was 8 days longer in patients with PPOI. Male gender, cancer, cardiac and respiratory co-morbidity, rectal resection, open/converted access, duration of operation, stoma formation and body mass index were associated with PPOI at univariate analysis (0.001< P< 0.048). PPOI was independently associated with male gender [adjusted odds ratio (OR), 4.2; 95%CI, 1.5-11.5], stoma formation (OR, 2.8; 95%CI, 1.2-6.8) and obesity (OR of obese vs. normal weight patients, 3.8, 95%CI, 1.2-12.0).
After colorectal resection, PPOI leads to a prolonged hospital stay and slower patient's recovery. An international standardized definition of PPOI is strongly needed to make comparable results from researches and to reliably identify patients with increased risk, also to improve the therapeutic preventive policies in these patients.
腹部手术后的术后肠梗阻延长（PPOI）可能对患者恢复产生不利影响。本研究的目的是评估择期行结直肠切除术患者中PPOI的发生率，并调查与PPOI相关的围手术期变量。
分析了连续428例行结直肠切除术的患者（中位年龄72岁，范围24 - 92岁；男女比例1.14）。数据是从一个前瞻性维护的电子数据库中回顾性提取的，时间跨度为五年。PPOI被定义为经历恶心和两次呕吐发作且进一步表现出肠道功能不足（无排气/排便）、肠鸣音消失和腹胀的患者术后需要插入鼻胃管。
PPOI的发生率为7%[95%置信区间（95%CI），4.8 - 9.9%]。PPOI患者的平均住院时间延长8天。在单因素分析中，男性、癌症、心脏和呼吸合并症、直肠切除术、开放/中转入路、手术时间、造口形成和体重指数与PPOI相关（0.001 < P < 0.048）。PPOI与男性独立相关[调整后的优势比（OR），4.2；95%CI，1.5 - 11.5]、造口形成（OR，2.8；95%CI，1.2 - 6.8）和肥胖（肥胖患者与正常体重患者的OR，3.8，95%CI，1.2 - 12.0）。
结直肠切除术后，PPOI导致住院时间延长和患者恢复缓慢。迫切需要PPOI的国际标准化定义，以便使研究结果具有可比性，并可靠地识别风险增加的患者，同时改善这些患者的治疗预防策略。
