The Dumont UCLA Transplant Center, Division of Liver and Pancreas transplantation, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA.
Hepato-Pancreato-Biliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
Transplantation. 2020 Mar;104(3):652-658. doi: 10.1097/TP.0000000000002879.
Temporary ileostomy during intestinal transplantation (ITx) is the standard technique for allograft monitoring. A detailed analysis of the ITx ileostomy has never been reported.
A retrospective review of a single-center ITx database was performed. The analysis was divided into ileostomy formation and takedown episodes.
One hundred thirty-five grafts underwent ileostomy formation, and 79 underwent ileostomy takedown. Median age at ITx was 7.7 years and weight was 23 kg. Allograft types were intestine (22%), liver/intestine (55%), multivisceral (16%), and modified multivisceral (7%). Sixty-four percent had 1-stage ITx, whereas 36% required 2-staged ITx. Final ileostomy types were end (20%), loop (10%), distal blowhole (59%), and proximal blowhole (11%). Ileostomy formation: Thirty-one grafts had complications (23%), including prolapse (26%), ischemia (16%), and parastomal hernia (19%). Twelve required surgical revision. There were no significant differences in graft type, ileostomy type, survival, and ileostomy takedown rate between grafts with and without complications. Colon inclusive grafts had higher complication rates (P = 0.002). Ileostomy takedown: Ileostomy takedown occurred at a median of 422 days post-ITx. Twenty-five complications occurred after 22 takedowns (28%), including small bowel obstruction (27%) and abscess (18%). Fifteen grafts required surgical correction. Recipients with complications had longer hospital stay (17 versus 9 d; P = 0.001) than those without complications. Graft type, ileostomy type, and survival were not different.
The first of its kind analysis of the surgical ileostomy after ITx reveals that most recipients can undergo successful ileostomy formation/takedown, complication rates are significant but within an acceptable range, and complications do not affect survival. This study demonstrates that the routine use of transplant ostomies remains an acceptable practice after ITx. However, true analysis of risk and benefit will require a randomized control trial.
在肠移植（ITx）期间，临时回肠造口术是同种异体移植物监测的标准技术。但对于 ITx 回肠造口术的详细分析从未有过报道。
对单中心 ITx 数据库进行回顾性分析。分析分为回肠造口术形成和关闭两个部分。
135 例移植物行回肠造口术形成术，79 例行回肠造口术关闭术。ITx 时的中位年龄为 7.7 岁，体重为 23kg。同种异体移植物类型为肠（22%）、肝/肠（55%）、多器官（16%）和改良多器官（7%）。64%的患者行 1 期 ITx，36%的患者需要 2 期 ITx。最终回肠造口术类型为末端（20%）、袢式（10%）、远端穿孔（59%）和近端穿孔（11%）。回肠造口术形成：31 例移植物发生并发症（23%），包括脱垂（26%）、缺血（16%）和造口旁疝（19%）。12 例需要手术修正。有和无并发症的移植物在移植物类型、造口类型、存活率和造口关闭率方面均无显著差异。包含结肠的移植物有更高的并发症发生率（P=0.002）。回肠造口术关闭：回肠造口术关闭的中位时间为 ITx 后 422 天。22 次关闭中有 25 例发生并发症（28%），包括小肠梗阻（27%）和脓肿（18%）。15 例移植物需要手术矫正。有并发症的患者住院时间更长（17 天比 9 天；P=0.001）。移植物类型、造口类型和存活率无差异。
这是首例关于 ITx 后外科回肠造口术的分析，结果显示大多数患者可以成功地进行回肠造口术形成/关闭，并发症发生率高，但在可接受的范围内，并发症并不影响存活率。本研究表明，在 ITx 后常规使用移植造口仍然是一种可接受的做法。然而，真正的风险和收益分析需要进行随机对照试验。
