慢性便秘造口术后患者报告的结局

Patient-Reported Outcome After Ostomy Surgery for Chronic Constipation.

作者信息

Iqbal Fareed, van der Ploeg Valerie, Adaba Franklin, Askari Alan, Murphy Jamie, Nicholls R John, Vaizey Carolynne

机构信息

Fareed Iqbal, MBChB, BMedSci (Hons), MRCS (Eng), Sir Alan Park's Department of Physiology, St Mark's Hospital, London, England. Valerie Van der Ploeg, MSc, Sir Alan Department of Physiology, St Mark's Hospital, London, England. Franklin Adaba, MRCS (Eng), MBBS, Sir Alan Park's Department of Physiology, St Mark's Hospital, London, England. Alan Askari, MBChB, MRCS (Eng), Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital, London, England. Jamie Murphy, PhD, MB ChirB, FRCS, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Paddington, London, England. R. John Nicholls, MS, FRCS, Sir Alan Park's Department of Physiology, St Mark's Hospital, London, England. Carolynne Vaizey, MBBS, FCS, FRCS, Sir Alan Park's Department of Physiology, St Mark's Hospital, London, England.

出版信息

J Wound Ostomy Continence Nurs. 2018 Jul/Aug;45(4):319-325. doi: 10.1097/WON.0000000000000445.

DOI:10.1097/WON.0000000000000445

PMID:29994858

Abstract

PURPOSE

The purpose of this study was to describe experiences of and evaluate psychosocial and health-related quality of life of individuals undergoing ostomy surgery for severe, chronic constipation.

METHODS

A search of the local ostomy archive and the electronic hospital episode statistics database was performed in a large tertiary referral center. Study outcomes were evaluated retrospectively using clinical notes and prospectively via administration of the City of Hope Ostomy Quality of Life questionnaire, Medical Outcomes Study Short Form-36, Hospital Anxiety and Depression tool, and a specially designed ostomy-specific questionnaire. Questionnaires were mailed and returned via post.

RESULTS

Twenty-four patients, with a median age of 44 years (interquartile range [IQR] = 31-56), who underwent ileostomy (n = 20) and colostomy (n = 4) over a 13-year period participated in the study. The vast majority of respondents (91%; n = 22) were female. Ten (41%) underwent laparoscopic surgery, 13 (54%) underwent open procedures, and 1 was converted from laparoscopic to open surgery. The mean length of stay (5.5 days vs 5.4 days) and the rate of complication did not differ between the 2 approaches. Fourteen patients (13 females, median age = 47.5 years; IQR = 23-70 years) responded to the postal questionnaires (58.3%). Adverse effects on health-related quality of life in the physical and social well-being domains were reported, and a further 86% of respondents reported psychological morbidity related to their ostomy. However, more than 70% were satisfied (median follow-up = 17 months; IQR = 0.16-8 years) with their quality of life despite a 20% reoperation rate.

CONCLUSIONS

An ostomy is a justified last-resort treatment option in selected individuals with severe, chronic constipation. Patients should be warned of the negative effects on health-related quality of life and the risk of complications. We advocate using an algorithm presented in this article.

摘要

目的

本研究旨在描述因严重慢性便秘接受造口术的个体的经历，并评估其心理社会及与健康相关的生活质量。

方法

在一家大型三级转诊中心对当地造口档案和电子医院病历统计数据库进行检索。研究结果通过回顾临床记录进行评估，并通过发放希望之城造口生活质量问卷、医学结局研究简表36、医院焦虑抑郁量表以及一份专门设计的造口特异性问卷进行前瞻性评估。问卷通过邮寄方式发放并回收。

结果

24名患者参与了本研究，他们在13年期间接受了回肠造口术（n = 20）和结肠造口术（n = 4），中位年龄为44岁（四分位间距[IQR]=31 - 56）。绝大多数受访者（91%；n = 22）为女性。10例（41%）接受了腹腔镜手术，13例（54%）接受了开放手术，1例由腹腔镜手术转为开放手术。两种手术方式的平均住院时间（5.5天对5.4天）和并发症发生率无差异。14名患者（13名女性，中位年龄 = 47.5岁；IQR = 23 - 70岁）回复了邮寄问卷（58.3%）。报告了对身体和社会福祉领域与健康相关生活质量的不良影响，另外86%的受访者报告了与造口相关的心理问题。然而，尽管再次手术率为20%，超过70%的患者（中位随访时间 = 17个月；IQR = 0.16 - 8年）对其生活质量感到满意。