Seifarth Claudia, Augustin Leonard N, Lehmann Kai S, Stroux Andrea, Lauscher Johannes C, Kreis Martin E, Holmer Christoph
Department of General-, Visceral- and Vascular Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Institute for Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Front Surg. 2021 May 21;8:642288. doi: 10.3389/fsurg.2021.642288. eCollection 2021.
Ileostomy is often required in patients undergoing bowel resections for inflammatory bowel diseases (IBD), colorectal cancer, and emergencies. Unfortunately, some patients develop a high-output stoma (HOS). This condition affects homeostasis and may be life threatening. We aimed to identify possible risk factors for the development of HOS. From 2012 to 2018, 296 patients who underwent ileostomy at Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin were retrospectively analyzed. Emergency operations were included. Diverting ileostomy, end ileostomies and anastomotic stomata with at least part ileum, were examined. HOS was defined as stoma output of more than 1,000 mL per day for more than 3 days. Univariate and multivariable analyses were used to detect potential risk factors for the development of HOS. 41 of 296 patients developed HOS (13.9%). Mortality was 0.3%. In the univariate analysis, age ( < 0.002), diagnosis (Crohn's disease, = 0.005), arterial hypertension ( = 0.023), surgical procedure (right-sided colectomy, small bowel resection, < 0.001), open technique ( < 0.002), emergencies ( = 0.014), and anastomotic ileostomy ( < 0.001) were identified as risk factors. In the multivariable logistic regression, older age, diagnosis (Crohn's disease) and surgical procedure (right-sided colectomy, separate ileostomy, small bowel resection) remained significant risk factors. The occurrence of HOS is a relevant problem after ileostomy. The identification of risk factors for a high-output may be helpful for monitoring, early diagnosis and initiation of therapy as well as in the planning of close follow-up care.
对于因炎症性肠病（IBD）、结直肠癌及急诊而接受肠道切除术的患者，通常需要进行回肠造口术。不幸的是，一些患者会出现高输出量造口（HOS）。这种情况会影响体内平衡，甚至可能危及生命。我们旨在确定发生HOS的可能危险因素。对2012年至2018年在柏林夏里特大学医学院本杰明·富兰克林校区接受回肠造口术的296例患者进行了回顾性分析。纳入急诊手术病例。对转流性回肠造口术、末端回肠造口术以及至少部分为回肠的吻合口造口进行了检查。HOS定义为造口每日输出量超过1000 mL且持续超过3天。采用单因素和多因素分析来检测发生HOS的潜在危险因素。296例患者中有41例出现HOS（13.9%）。死亡率为0.3%。在单因素分析中，年龄（<0.002）、诊断（克罗恩病，=0.005）、动脉高血压（=0.023）、手术方式（右半结肠切除术、小肠切除术，<0.001）、开放手术技术（<0.002）、急诊情况（=0.014）以及吻合口回肠造口术（<0.001）被确定为危险因素。在多因素逻辑回归分析中，年龄较大、诊断（克罗恩病）以及手术方式（右半结肠切除术、单独回肠造口术、小肠切除术）仍然是显著的危险因素。回肠造口术后HOS的发生是一个相关问题。识别高输出量的危险因素可能有助于监测、早期诊断和开始治疗，以及规划密切的后续护理。
