Department of Surgery, University of Regensburg, Regensburg, Germany.
Department of Surgery, Klinik München Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany.
Int J Colorectal Dis. 2021 Oct;36(10):2119-2125. doi: 10.1007/s00384-020-03823-4. Epub 2021 Apr 30.
End-ileostomy after two-staged ileocolic resection is frequently performed in Crohn's disease patients at high risk for postoperative complications. However, there is paucity on data regarding the morbidity after the stoma reversal.
One hundred thirty patients undergoing closure of end-ileostomy between 1994 and 2016 were included. Data collection was retrospective in 11 first, and it was prospective in 119 last patients. Anastomotic complications were defined as anastomotic leak, perianastomotic abscess, and perianastomotic peritonitis.
The median interval between ileostomy construction and reversal was 4.0 months. Ninety-seven of 121 patients with available data (80%) gained weight between both surgeries. Hemoglobin level increased between surgeries in 107 patients (85%). Fifteen patients (11.5%) received parenteral fluid substitution or parenteral nutrition between both surgeries. There were 37 hospital readmissions during the time between stoma construction and reversal (29%). After ileostomy reversal, 14 patients developed anastomotic complications (11%). By multivariate regression analysis, preoperative steroid intake (hazard ratio 4.5, 95% CI: 1.11-18.0, p = 0.035) and hospital readmission for infectious complications (HR 4.5, 95% CI: 1.11-18.0, p = 0.035) were statistically significantly associated with an increased risk to develop postoperative anastomotic complications. There were no postoperative deaths.
Closure of end-ileostomy could be complicated by some serious morbidity. These risks should be taken into consideration weighing carefully between the one- and two-stage ileocolic resection in Crohn's disease patients.
在克罗恩病患者中，对于术后并发症风险较高的患者，通常会进行两阶段回肠结肠切除术后的回肠造口关闭术。然而，对于造口回纳术后的发病率，相关数据却很少。
本研究纳入了 1994 年至 2016 年间行回肠造口关闭术的 130 例患者。前 11 例患者的数据采集为回顾性，后 119 例患者的数据采集为前瞻性。吻合口并发症定义为吻合口漏、吻合口周围脓肿和吻合口周围腹膜炎。
回肠造口与回肠造口关闭之间的中位间隔时间为 4.0 个月。121 例有可用数据的患者中有 97 例（80%）在两次手术之间体重增加。107 例患者的血红蛋白水平在两次手术之间升高（85%）。两次手术之间有 15 例（11.5%）患者接受了肠外补液或肠外营养。在造口构建和回纳期间，有 37 例患者需要住院治疗（29%）。回肠造口关闭后，14 例患者出现吻合口并发症（11%）。通过多变量回归分析，术前类固醇摄入（风险比 4.5，95%可信区间：1.11-18.0，p=0.035）和因感染性并发症住院（HR 4.5，95%可信区间：1.11-18.0，p=0.035）与术后吻合口并发症的风险增加显著相关。没有术后死亡病例。
回肠造口关闭术可能会出现一些严重的并发症。在克罗恩病患者中，应权衡利弊，慎重考虑行单阶段或两阶段回肠结肠切除术。
