腹腔镜与开腹结直肠手术后回肠袢式造口关闭术的早期术后结果。
Early postoperative outcomes of diverting loop ileostomy closure surgery following laparoscopic versus open colorectal surgery.
机构信息
Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
出版信息
Surg Endosc. 2021 Jun;35(6):2509-2514. doi: 10.1007/s00464-020-07662-w. Epub 2020 May 26.
BACKGROUND
Although diverting loop ileostomy (DLI) formation reduces the consequences of anastomotic leak and may also decrease the incidence of this severe complication, DLI closure can result in significant complications. The laparoscopic approach in colorectal surgery has numerous benefits, including reduced length of stay (LOS), less wound infection, and better cosmesis. The aim of this study was to determine whether a laparoscopic approach at the time of the ileostomy creation has a beneficial effect on the outcomes of ileostomy closure.
METHODS
A retrospective analysis of an IRB-approved prospective database was performed for all patients who underwent DLI closure between 2010 and 2017. Patients' demographics, operative reports, and postoperative course were reviewed. Statistical analyses were performed using SPSS software and included descriptive statistics, Chi-square for categorical variables, and Student's t tests for continuous variables. Skewed variables were compared using the non-parametric Mann-Whitney U test. Regression analysis for overall complications and LOS were preformed to further assess the impact of laparoscopy.
RESULTS
We identified 795 patients (363 females) who underwent DLI reversal surgery. The surgical approach in the index operation was laparoscopy in 65% of patients. Conversion to laparotomy at the ileostomy closure occurred in 6.1% of patients. The overall complication rate was lower and the LOS was shorter for patients who underwent DLI closure following laparoscopic surgery. Laparoscopy at the index operation was also associated with a lower incidence of postoperative ileus and a lower estimated blood loss (EBL) at the time of DLI reversal. Multivariate regression analysis found laparoscopy to have significant benefits compared to laparotomy for overall complications and for LOS.
CONCLUSION
Ileostomy closure following laparoscopic colorectal surgery offers benefits including reductions in LOS and overall complications.
背景
虽然转流回肠造口术（DLI）的形成减少了吻合口漏的后果，并且还可能降低这种严重并发症的发生率，但 DLI 关闭可能会导致严重的并发症。腹腔镜在结直肠手术中有许多优点，包括住院时间（LOS）缩短、伤口感染减少和美容效果更好。本研究的目的是确定在造口术时采用腹腔镜方法是否对造口关闭的结果有有益的影响。
方法
对 2010 年至 2017 年间所有接受 DLI 关闭的患者进行了经 IRB 批准的前瞻性数据库的回顾性分析。回顾了患者的人口统计学资料、手术报告和术后过程。使用 SPSS 软件进行统计分析，包括描述性统计、分类变量的卡方检验和连续变量的学生 t 检验。使用非参数 Mann-Whitney U 检验比较偏态变量。对总体并发症和 LOS 进行回归分析，以进一步评估腹腔镜的影响。
结果
我们确定了 795 例（363 例女性）接受 DLI 反转手术的患者。在索引手术中，65%的患者采用腹腔镜手术。6.1%的患者在 DLI 关闭时转为剖腹手术。与接受剖腹手术的患者相比，接受腹腔镜手术的患者总体并发症发生率较低， LOS 较短。在索引手术中进行腹腔镜手术也与术后肠梗阻发生率较低和 DLI 反转时估计失血量（EBL）较低相关。多变量回归分析发现，与剖腹手术相比，腹腔镜在总体并发症和 LOS 方面具有显著优势。
结论
腹腔镜结直肠手术后行回肠造口关闭术具有减少 LOS 和总体并发症的优势。
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