Division of Colorectal Surgery, University Surgical Cluster, National University Health System, System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Rd, Singapore, Singapore.
Int J Colorectal Dis. 2019 Dec;34(12):2075-2080. doi: 10.1007/s00384-019-03428-6. Epub 2019 Nov 9.
An ileostomy is usually created to avert systemic sepsis in a patient with a tenuous anastomosis. However, what is often not reported are the numerous issues facing these patients subsequently, ranging from readmissions, non-reversal of the stoma, and complications from the closure. This study was performed to identify these issues among patients following creation of an ileostomy.
We conducted a retrospective analysis of consecutive patients who had an ileostomy created from January 2011 to December 2016 at two institutions. Statistical analysis was performed to identify risk factors associated with readmissions and ileostomy non-reversal.
In total, 193 patients had an ileostomy created during the study period. Twenty-six (13.5%) patients developed stoma-related complications requiring readmission. The most common cause of readmission (9.3%) was due to dehydration and acute kidney injury secondary to high stoma output. One hundred thirty (67.4%) patients had their ileostomy reversed. On multivariate analysis, only stomas created during an ultra-low anterior resection were associated with reversal (OR 2.88 [95% CI, 1.24-6.68]; p = 0.014). Among the patients who underwent ileostomy reversal, seven (3.6%) patients developed complications from their ileostomy reversal. Four patients (2.1%) suffered from an anastomotic leak which required repeat surgical intervention with one mortality from the ensuing sepsis.
Almost half of the patients who had an Ileostomy had an undesirable outcome, including readmissions, non-reversal, and post-operative complications following closure. Patients need to be properly counselled about the risks involved prior to the index operation.
在吻合口脆弱的患者中，通常会创建回肠造口术以避免全身败血症。然而，通常没有报道的是这些患者随后面临的许多问题，范围从再次入院，造口无法逆转以及关闭并发症。进行这项研究是为了确定在创建回肠造口术后患者中存在的这些问题。
我们对在两个机构于 2011 年 1 月至 2016 年 12 月期间创建回肠造口术的连续患者进行了回顾性分析。进行统计分析以确定与再次入院和回肠造口术无法逆转相关的危险因素。
在研究期间，共有 193 例患者接受了回肠造口术。26 例（13.5％）患者因肠造口相关并发症需要再次入院。导致再次入院的最常见原因（9.3％）是由于高肠造口输出导致的脱水和急性肾损伤。有 130 例（67.4％）患者的回肠造口术得到了逆转。在多变量分析中，只有在超低位前切除术期间创建的造口与逆转相关（OR 2.88 [95％CI，1.24-6.68]；p=0.014）。在接受回肠造口术逆转的患者中，有 7 例（3.6％）患者发生了回肠造口术逆转的并发症。有 4 名患者（2.1％）患有吻合口漏，需要再次进行手术干预，其中 1 名患者因随后的败血症而死亡。
几乎有一半的接受回肠造口术的患者出现了不理想的结果，包括再次入院，造口无法逆转以及关闭后的术后并发症。在进行索引手术之前，需要对患者进行适当的咨询，告知其相关风险。
