Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Am J Surg. 2021 Mar;221(3):594-597. doi: 10.1016/j.amjsurg.2020.11.029. Epub 2020 Nov 18.
The surgical management of large bowel obstruction (LBO) is heterogeneous and influenced by multiple variables. The aim of this study was to analyze and compare the surgical interventions and outcomes of patients necessitating surgery for LBO.
Patients with LBO between 2000 and 2017 were included. Main outcomes measures are intraoperative findings, operative management, post-operative outcomes and stoma closure rates.
133 patients were included with predominately left-sided obstruction (82%). The most common etiology was colorectal cancer (44%) followed by extrinsic malignant compression (29%). The most common operation performed was fecal diversion without resection (46%). This group had significantly more stage 4 carcinoma, carcinomatosis and had the lowest stoma closure rate (16%). Eighty-six percent of the operated patients underwent fecal diversion, of these, 27% had stoma reversal at 6 months. Patients that had a resection and anastomosis with diverting loop ileostomy were most likely to undergo stoma reversal (p = 0.005) and had the lowest number of patients with stage-IV carcinoma.
In this single institution analysis, the management of LBO entails high operative and stoma rates, with less than 30% of patient undergoing stoma closure. Resection, anastomosis and DLI had the highest chance of stoma reversal.
大肠梗阻（LBO）的手术治疗方法多样，受多种因素影响。本研究旨在分析和比较需要手术治疗 LBO 的患者的手术干预和结果。
纳入 2000 年至 2017 年间患有 LBO 的患者。主要观察指标为术中发现、手术管理、术后结果和造口关闭率。
共纳入 133 例患者，以左侧梗阻为主（82%）。最常见的病因是结直肠癌（44%），其次是外压性恶性肿瘤（29%）。最常见的手术是不切除的粪便转流术（46%）。这组患者的 4 期癌、癌转移更多，造口关闭率最低（16%）。86%的手术患者进行粪便转流，其中 27%的患者在 6 个月时进行造口反转。行切除、吻合和预防性回肠造口术的患者最有可能进行造口反转（p=0.005），且 4 期癌患者最少。
在本单中心分析中，LBO 的治疗需要进行高手术和造口术，只有不到 30%的患者进行了造口关闭。切除、吻合和预防性回肠造口术具有最高的造口反转机会。
