Jinling Hospital Research Institute General Surgery, Nanjing University, School of Medicine, No. 305 East Zhongshan Road, Nanjing, 210002, China.
Dig Dis Sci. 2020 Jan;65(1):243-249. doi: 10.1007/s10620-019-05753-w. Epub 2019 Jul 31.
The rate of postoperative ileus following stoma closure is high in patients with Crohn's disease and temporary enterostomy.
To evaluate the effect of chyme reinfusion on postoperative outcomes including ileus in these patients.
Patients were screened from January 2012 to December 2017 and divided into chyme reinfusion group (n = 33) and non-chyme reinfusion group (n = 84). The following 30-day postoperative outcomes were evaluated. Univariate and multivariate analyses and propensity score matching were performed to identify risk factors for these postoperative outcomes.
The incidence of postoperative ileus was significantly lower in the chyme reinfusion than in non-chyme reinfusion group, which had been confirmed by the results after matching (3/26 vs 11/26, p = 0.012). The rate of postoperative diarrhea was significantly lower in the chyme reinfusion group compared with non-chyme reinfusion group, whereas the difference was not significant after matching (2/26 vs 6/26, p = 0.191). Additionally, the postoperative length of stay was significantly shorter in the chyme reinfusion than in non-chyme reinfusion group before and after propensity score matching. In the multivariate analysis, chyme reinfusion was an independent protective factor for postoperative ileus (odds ratio 0.218; 95% confidence interval 0.05-0.95; p = 0.042) and for postoperative length of stay (coefficient - 0.191; 95% confidence interval - 0.350 to - 0.032, p = 0.019).
Chyme reinfusion was associated with lower rate of postoperative ileus and shorter length of stay following stoma closure in Crohn's patients with temporary ileostomy. Further randomized clinical trial between patients with or without chyme reinfusion was needed to confirm these conclusions.
克罗恩病患者行暂时性肠造口术后行肠造口关闭术，术后肠麻痹的发生率较高。
评估回输食糜对这些患者术后结果（包括肠麻痹）的影响。
对 2012 年 1 月至 2017 年 12 月间的患者进行筛选，分为回输食糜组（n=33）和未回输食糜组（n=84）。评估术后 30 天的结果。进行单变量和多变量分析及倾向评分匹配，以确定这些术后结果的危险因素。
回输食糜组的术后肠麻痹发生率明显低于未回输食糜组，匹配后结果得到证实（3/26 比 11/26，p=0.012）。回输食糜组的术后腹泻发生率明显低于未回输食糜组，但匹配后差异无统计学意义（2/26 比 6/26，p=0.191）。此外，回输食糜组的术后住院时间明显短于未回输食糜组，匹配前后差异均有统计学意义。多变量分析显示，回输食糜是术后肠麻痹（比值比 0.218；95%置信区间 0.05-0.95；p=0.042）和术后住院时间（系数-0.191；95%置信区间-0.350 至-0.032，p=0.019）的独立保护因素。
在有暂时性肠造口的克罗恩病患者中，肠造口关闭术后回输食糜与术后肠麻痹发生率降低和住院时间缩短相关。需要进一步开展有无回输食糜的患者间的随机临床试验来证实这些结论。
