将失败的回肠肛管吻合术转换为可控性回肠造口术是否是长期失败的危险因素？

Is Conversion of a Failed IPAA to a Continent Ileostomy a Risk Factor for Long-term Failure?

作者信息

Aytac Erman, Dietz David W, Ashburn Jean, Remzi Feza H

机构信息

Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.

Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.

出版信息

Dis Colon Rectum. 2019 Feb;62(2):217-222. doi: 10.1097/DCR.0000000000001277.

DOI:10.1097/DCR.0000000000001277

PMID:30451753

Abstract

BACKGROUND

A continent ileostomy may be offered to patients in hopes of avoiding permanent ileostomy. Data on the outcomes of continent ileostomy patients with a history of a failed IPAA are limited.

OBJECTIVE

This study aimed to assess whether a history of previous failed IPAA had an effect on continent ileostomy survival and the long-term outcomes.

DESIGN

This was a retrospective cohort study.

SETTINGS

This investigation took place in a high-volume, specialized colorectal surgery department.

PATIENTS

Patients who underwent continent ileostomy construction after IPAA failure between 1982 and 2013 were evaluated and compared with patients who have no history of IPAA surgery.

MAIN OUTCOME MEASURES

Functional outcomes and long-term complications were compared.

RESULTS

A total of 67 patients fulfilled the case-matching criteria and were included in the analysis. Requirement of major (52% vs 61%; p = 0.756) and minor (15% vs 19%; p = 0.492) revisions were comparable between patients who had continent ileostomy after a failed IPAA and those who had continent ileostomy without having a previous restorative procedure. Intubations per day (5 vs 5; p = 0.804) and per night (1 vs 1; p = 0.700) were similar in both groups. Our data show no clear relationship between failure of continent ileostomy and history of failed IPAA (p = 0.638). The most common cause of continent ileostomy failure was enterocutaneous/enteroenteric fistula (n = 14). Six patients died during the study period because of other causes unrelated to continent ileostomy.

LIMITATIONS

This study was limited by its retrospective and nonrandomized nature.

CONCLUSIONS

Converting a failed IPAA to a continent ileostomy did not worsen continent ileostomy outcomes in this selected group of patients. When a redo IPAA is not feasible, continent ileostomy can be offered as an alternative to conventional end ileostomy in highly motivated patients. See Video Abstract at http://links.lww.com/DCR/A803.

摘要

背景

可为患者提供可控性回肠造口术，以期避免永久性回肠造口术。关于有IPAA失败史的可控性回肠造口术患者结局的数据有限。

目的

本研究旨在评估既往IPAA失败史是否对可控性回肠造口术的存活情况及长期结局产生影响。

设计

这是一项回顾性队列研究。

地点

本研究在一个高容量的专业结直肠外科进行。

患者

对1982年至2013年间IPAA失败后接受可控性回肠造口术构建的患者进行评估，并与无IPAA手术史的患者进行比较。

主要观察指标

比较功能结局和长期并发症。

结果

共有67例患者符合病例匹配标准并纳入分析。IPAA失败后接受可控性回肠造口术的患者与未接受过先前恢复性手术而接受可控性回肠造口术的患者相比，主要（52%对61%；p = 0.756）和次要（15%对19%；p = 0.492）修复的需求相当。两组患者每天（5次对5次；p = 0.804）和每晚（1次对1次；p = 0.700）的插管次数相似。我们的数据显示可控性回肠造口术失败与IPAA失败史之间无明确关联（p = 0.638）。可控性回肠造口术失败的最常见原因是肠皮肤/肠肠瘘（n = 14）。6例患者在研究期间因与可控性回肠造口术无关的其他原因死亡。