Goret Nuri Emrah, Goret Ceren Canbey, Cetin Kenan, Agachan Ahmet Feran
Ann Ital Chir. 2019;90:324-329.
The goal of the study is to describe postoperative complications observed after colostomy reversal and to define possible risk factor(s) for complication.s after colostomy closure PATIENTS-METHODS: Patients who underwent colostomy closure in Department of General Surgery, Dr Lutfi Kirdar Kartal Education and Research Hospital between January 2007 and January 2015 were enrolled. Patients with double-barrel ileo-colostomy, Devine's colostomy and tube cecostomy were excluded from study. Demographics, data regarding the first operation and those regarding the reversal operation were analyzed and compared.
Total 168 patients [118 (70.1%) male, average age=52.8±15.6] were included. Most common reasons for stoma formation were malignancy [n=63 (37.5%)] and diverticular perforation [40 (23.8%)]. Index operation was performed under emergency conditions in 142 (84.5%) patients. End colostomy was the most common stoma type in emergent cases and loop sigmoidostomy in elective cases. Postoperative complication was observed in 36 (21.4%) patients. Nine (5.3%) patients developed anastomotic leak. Of those, 8 (4.8%) was necessitated reoperation and 1 (0.6%) was treated conservatively. Postoperative mortality was 5 (2.9%). At multivariate analysis, DM was the independent risk factor for surgical site infection and evisceration (p<0.01). DM was present in 6 (66.7%) cases who had had an anastomotic leak and leak was more common compared to non-diabetics (p<0.05). Patients waiting more than 3 months before stoma reversal had experienced more anastomotic leak compared to those waiting less (p<0.05).
Closure of colostomy has a significant morbidity and mortality, and the physician should be more careful in postoperative follow-up in patients who had comorbidities, especially diabetes mellitus.
Anastomotic leak, Colostomy, Postoperative complication.
本研究的目的是描述结肠造口回纳术后观察到的术后并发症，并确定结肠造口关闭术后并发症的可能危险因素。
纳入2007年1月至2015年1月在卢特菲·基尔达尔·卡尔塔尔教育与研究医院普通外科接受结肠造口关闭术的患者。双腔回肠结肠造口术、迪瓦恩结肠造口术和管式盲肠造口术患者被排除在研究之外。分析并比较人口统计学资料、首次手术和回纳手术的数据。
共纳入168例患者[118例（70.1%）男性，平均年龄=52.8±15.6岁]。造口形成的最常见原因是恶性肿瘤[n=63例（37.5%）]和憩室穿孔[40例（23.8%）]。142例（84.5%）患者在急诊情况下进行了首次手术。末端结肠造口是急诊病例中最常见的造口类型，而袢式乙状结肠造口是择期病例中最常见的造口类型。36例（21.4%）患者出现术后并发症。9例（5.3%）患者发生吻合口漏。其中，8例（4.8%）需要再次手术，1例（0.6%）保守治疗。术后死亡率为5例（2.9%）。多因素分析显示，糖尿病是手术部位感染和脏器脱出的独立危险因素（p<0.01）。6例（66.7%）发生吻合口漏的患者患有糖尿病，与非糖尿病患者相比，吻合口漏更常见（p<0.05）。造口回纳前等待超过3个月的患者比等待时间较短的患者发生更多的吻合口漏（p<0.05）。
结肠造口关闭术有显著的发病率和死亡率，医生对有合并症的患者，尤其是糖尿病患者，术后随访应更加谨慎。
吻合口漏；结肠造口术；术后并发症
