行回肠袢式造口术治疗艰难梭菌结肠炎的患者不存在生存优势。
No survival advantage exists for patients undergoing loop ileostomy for clostridium difficile colitis.
机构信息
College of Medicine, Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA.
Center for Advanced Surgical Technology, Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6245, USA.
出版信息
Am J Surg. 2019 Jan;217(1):34-39. doi: 10.1016/j.amjsurg.2018.09.023. Epub 2018 Sep 22.
BACKGROUND
We aim to compare outcomes between loop ileostomy (LI) and total abdominal colectomy (TAC) for clostridium difficile infection (CDI) and hypothesize that LI is associated with fewer complications.
METHODS
The 2011-2016 ACS-NSQIP database was queried for patients undergoing LI or TAC for CDI. Patients with high outlying age, LOS, and operative time were excluded. Statistics were performed using IBM-SPSS and NCSS PASS-11.
RESULTS
Of 457 patients identified, 47 underwent LI. Predicted morbidity was higher in the TAC cohort (62% vs. 37%, p < 0.001). Patients in the LI cohort experienced fewer complications (72% vs. 87%, p = 0.021); however, mortality did not differ between LI (36%) and TAC (31%). Blood transfusions were more than twice as frequent in the TAC cohort (54% vs. 19%, p < 0.001). Four patients in the LI cohort required reoperation; however, none required colectomy.
CONCLUSIONS
No mortality difference was observed between LI and TAC. Prospective studies are required to determine the utility of LI.
SUMMARY
An analysis of the ACS-NSQIP database was performed and demonstrates that no survival benefit exists for patients who undergo loop ileostomy for C difficile infection compared to those who undergo total colectomy; however, patients who undergo loop ileostomy are likely to retain their colon with low risk of requiring subsequent colectomy.
背景
我们旨在比较回肠造口术（LI）和全腹部结肠切除术（TAC）治疗艰难梭菌感染（CDI）的结果，并假设 LI 与更少的并发症相关。
方法
对 2011-2016 年 ACS-NSQIP 数据库中因 CDI 而行 LI 或 TAC 的患者进行了查询。排除年龄、 LOS 和手术时间过高的患者。使用 IBM-SPSS 和 NCSS PASS-11 进行统计学分析。
结果
在 457 例患者中，47 例患者行 LI。TAC 组的预测发病率较高（62% vs. 37%，p<0.001）。LI 组患者的并发症较少（72% vs. 87%，p=0.021）；然而，LI（36%）和 TAC（31%）之间的死亡率没有差异。TAC 组输血的频率是 LI 组的两倍多（54% vs. 19%，p<0.001）。LI 组有 4 例患者需要再次手术，但无一例需要结肠切除术。
结论
LI 和 TAC 之间未观察到死亡率差异。需要前瞻性研究来确定 LI 的实用性。
总结
对 ACS-NSQIP 数据库进行了分析，结果表明，与接受全结肠切除术的患者相比，接受回肠造口术治疗艰难梭菌感染的患者没有生存获益；然而，接受回肠造口术的患者可能会保留其结肠，后续需要结肠切除术的风险较低。
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