Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire.
Dartmouth College, Hanover, New Hampshire.
J Surg Res. 2019 Sep;241:135-140. doi: 10.1016/j.jss.2019.03.041. Epub 2019 Apr 22.
Diverticular disease is common worldwide. A subset of these patients will choose to undergo elective surgical resection because of symptoms or complicated disease. The aim of this study was to evaluate changes in bowel function after elective sigmoid resection for diverticular disease.
We retrospectively reviewed patients seen at our institution from May 2015 to July 2018 who underwent elective sigmoid resection for diverticular disease. We used the Colorectal Functional Outcome (COREFO) questionnaire, a validated questionnaire that assesses bowel function in five domains and a global function score (scores 0-100, with higher score indicating worse function). We obtained questionnaire data at baseline, as well as at postoperative follow-up, and a paired t-test was used to compare.
Forty-nine patients met criteria for inclusion in this study. The median time between questionnaire completion was 70 days (interquartile range: 56 to 85). The mean age was 60 ± 12 years, with 57% female patients. Thirty-six (73%) patients underwent sigmoidectomy alone and 13 (27%) underwent sigmoidectomy with fistula repair. Six patients (12%) had a diverting loop ileostomy in addition to sigmoidectomy and underwent a subsequent reversal. Overall, there were no differences in any of the five domains or the total Colorectal Functional Outcome score from baseline to postintervention.
In our cohort, bowel function did not significantly change in the early postoperative period after elective sigmoid resection for diverticular disease. Surgeons should counsel patients, especially symptomatic ones, that bowel function will likely be no different at time of postoperative follow-up.
憩室病在世界范围内较为常见。这些患者中有一部分会因症状或复杂的疾病而选择择期手术切除。本研究旨在评估择期乙状结肠切除术治疗憩室病后肠功能的变化。
我们回顾性分析了 2015 年 5 月至 2018 年 7 月在我院就诊的因憩室病行择期乙状结肠切除术的患者。我们使用结直肠功能结局(COREFO)问卷,这是一种经过验证的问卷,可评估五个领域的肠功能和一个总体功能评分(评分 0-100,分数越高表示功能越差)。我们在基线时和术后随访时获得问卷数据,并使用配对 t 检验进行比较。
49 例患者符合纳入本研究的标准。完成问卷的中位时间为 70 天(四分位距:56-85)。平均年龄为 60±12 岁,女性占 57%。36 例(73%)患者仅行乙状结肠切除术,13 例(27%)患者行乙状结肠切除术加瘘管修补术。6 例(12%)患者除乙状结肠切除术外还行结肠造口术,并随后进行了造口还纳术。总体而言,从基线到干预后,五个领域或结直肠功能总结局评分均无差异。
在我们的队列中,择期乙状结肠切除术治疗憩室病后,早期术后肠功能并未明显改变。外科医生应告知患者,尤其是有症状的患者,术后随访时肠功能可能并无不同。