Department of Surgery, Queen Elizabeth Hospital, 30 Gascoigne Road, Jordan, Kowloon, Hong Kong.
Langenbecks Arch Surg. 2021 Mar;406(2):349-356. doi: 10.1007/s00423-020-02054-z. Epub 2021 Jan 6.
A defunctioning stoma is essential in reducing symptomatic leakage after colorectal surgery, particularly after lower anterior resection. Subsequent stoma closure is associated with morbidity and rarely mortality. This study aimed to identify the risk factors associated with post-operative complications related to stoma closure.
This retrospective cohort included patients who have undergone elective stoma closure between 2015 and 2017. Patient demographics, pre-morbidities, use of systemic therapy, stoma characteristics, and post-operative complications were retrieved from electronic records. Univariate and multivariate analysis was carried out to identify risk factors of stoma closure related morbidity.
Ninety patients were included with a median age of 65 years, of which 58 (64.4%) of them were male. Sixty-nine (76.7%) patients had loop colostomy, while the rest had loop ileostomy. Fifty-four (60%) patients received neoadjuvant or adjuvant therapy. The median time interval from stoma creation to closure was 15 months. Nineteen (21.1%) patients had post-operative complications. The two most commonly observed post-operative complications were wound complications (16.7%) and intra-abdominal collections (6.7%). Fifteen (16.7%) patients developed an incisional hernia. The median follow-up time was 29 months. There was no 30-day mortality in this cohort. In multivariate analysis, adjuvant chemotherapy was associated with a higher risk of wound complications (p = 0.027). Higher risk of incisional hernia was seen in patients with history of hypertension (p = 0.046), use of adjuvant chemotherapy (p = 0.042) and stoma-related complications before closure (p = 0.002). Male patients might be associated with a higher risk of incisional hernia.
Adjuvant chemotherapy is associated with a higher risk of post-operative complications, particularly with wound complications. Male patients, hypertension, adjuvant chemotherapy, and stoma-related complications are associated with a higher risk of incisional hernia.
在结直肠手术后，特别是低位前切除术后，功能性造口对于减少症状性漏液至关重要。随后的造口关闭与发病率相关，很少与死亡率相关。本研究旨在确定与造口关闭相关的术后并发症相关的危险因素。
本回顾性队列研究纳入了 2015 年至 2017 年间接受择期造口关闭的患者。从电子病历中检索患者的人口统计学、术前合并症、系统治疗的使用、造口特征和术后并发症。进行单因素和多因素分析，以确定造口关闭相关发病率的危险因素。
共纳入 90 例患者，中位年龄为 65 岁，其中 58 例（64.4%）为男性。69 例（76.7%）患者行肠袢造口术，其余患者行肠袢造口术。54 例（60%）患者接受了新辅助或辅助治疗。从造口创建到关闭的中位时间间隔为 15 个月。19 例（21.1%）患者发生术后并发症。最常见的两种术后并发症是伤口并发症（16.7%）和腹腔内积液（6.7%）。15 例（16.7%）患者发生切口疝。中位随访时间为 29 个月。本队列中无 30 天内死亡病例。多因素分析显示，辅助化疗与伤口并发症的风险增加相关（p=0.027）。高血压史（p=0.046）、辅助化疗（p=0.042）和造口关闭前相关并发症（p=0.002）的患者发生切口疝的风险更高。男性患者可能与切口疝的风险增加相关。
辅助化疗与术后并发症的风险增加相关，特别是与伤口并发症相关。男性患者、高血压、辅助化疗和造口相关并发症与切口疝的风险增加相关。
