Hara Yutaro, Miura Takuya, Sakamoto Yoshiyuki, Morohashi Hajime, Nagase Hayato, Hakamada Kenichi
Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
BMC Surg. 2020 Apr 28;20(1):83. doi: 10.1186/s12893-020-00734-7.
The objectives of this study are to identify causes of high-output stoma (HOS) and outlet obstruction (OO), which are major complications of diverting ileostomy.
A retrospective analysis was performed in 103 patients who underwent colorectal surgery and diverting ileostomy between December 2015 and November 2018.
HOS was found in 32 patients (31.1%) and OO in 19 (18.4%). Organ/space surgical site infection (SSI), anastomotic leakage and OO were significant HOS-related factors in univariate analysis, and OO (odds ratio [OR] 3.39, p = 0.034) was a independent HOS-related factor in multivariate analysis. Organ/space SSI and male were significant OO-related factors in univariate analysis, and organ/space SSI (OR 3.77, p = 0.018) was a independent OO-related factor in multivariate analysis. The white blood cell (WBC) count on postoperative day (POD) 3 was significantly higher in the HOS group compared to the non-HOS group (9765 vs. 8130 /mL, p < 0.05), and the WBC count (9400 vs. 7475 /mL, p < 0.05) and C-reactive protein level (6.01 vs. 2.92 mg/L, p < 0.05) on POD 6 were significantly higher in the OO group compared to the non-OO group.
Organ/space infection is involved in the common pathology of HOS and OO. Decreased intestinal absorption due to intestinal edema caused by organ/space SSI and relative stenosis at the abdominal wall-penetrating site are major causes of HOS and OO.
本研究的目的是确定高输出量造口（HOS）和出口梗阻（OO）的原因，这两者是转流性回肠造口术的主要并发症。
对2015年12月至2018年11月期间接受结直肠手术并行转流性回肠造口术的103例患者进行回顾性分析。
32例患者（31.1%）出现HOS，19例（18.4%）出现OO。在单因素分析中，器官/腔隙手术部位感染（SSI）、吻合口漏和OO是与HOS相关的显著因素，在多因素分析中，OO（比值比[OR] 3.39，p = 0.034）是与HOS相关的独立因素。在单因素分析中，器官/腔隙SSI和男性是与OO相关的显著因素，在多因素分析中，器官/腔隙SSI（OR 3.77，p = 0.018）是与OO相关的独立因素。HOS组术后第3天的白细胞（WBC）计数显著高于非HOS组（9765对8130 /mL，p < 0.05），OO组术后第6天的WBC计数（9400对7475 /mL，p < 0.05）和C反应蛋白水平（6.01对2.92 mg/L，p < 0.05）显著高于非OO组。
器官/腔隙感染参与了HOS和OO的共同病理过程。器官/腔隙SSI引起的肠水肿导致的肠道吸收减少以及腹壁穿透部位的相对狭窄是HOS和OO的主要原因。
