Attending Surgeon, Department of Colorectal Surgery, RinggoldID:%2038020China Medical University Hospital, Taichung, Taiwan.
Associate professor Surgical Research Unit, Department of Surgery, Medical University of Graz, and Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Poissy, France.
Surg Innov. 2022 Dec;29(6):697-704. doi: 10.1177/15533506211070177. Epub 2022 Feb 28.
No universal consensus exists on the management of intraperitoneal anastomosis leakage after colonic surgery. The aim of the study was to evaluate the outcomes of laparoscopic reintervention without stoma creation for intraperitoneal leaks after colonic surgery.
Single tertiary center study conducted from January 2010 to December 2020. 54 patients with intraperitoneal leakage were divided into 2 groups according to whether they received a stoma (n = 37) or not (n = 17) during laparoscopic reintervention. Short term outcome was analyzed.
Patients in the no stoma group had lower American Society of Anesthesiologists (ASA) score ( = .009), lower Acute Physiology And Chronic Health Evaluation II (APACHE II) score (5 vs. 10; < .001) compared with the stoma group. Intensive care unit admission (43.2% vs. 5.8%; = .006) and major complications (35.1% vs. 5.8%; = .015) occurred more in the stoma group compared to the no stoma group. After multivariate logistic regression analysis, initial surgical procedure ( = .001) and APACHE II score ( = .039) were significant predictors of no stoma. The APACHE II score( = .035) was an independent predictor of major complications. Finally, Receiver Operating Characteristic curve analysis showed that the cutoff value of APACHE II score for no stoma was 7.5.
In our study, APACHE II score was an independent predictor of stoma formation and the cutoff value of APACHE II score for no stoma was 7.5. Our results need to be confirmed by larger and randomized studies. In particular, a specific APACHE II threshold to omit a stoma in this setting remains to be determined.
结肠手术后腹腔吻合口漏的处理尚无统一共识。本研究旨在评估腹腔镜再次干预而不造瘘治疗结肠手术后腹腔漏的效果。
这是一项单中心回顾性研究，于 2010 年 1 月至 2020 年 12 月进行。根据腹腔镜再次干预时是否造瘘（n = 37）将 54 例腹腔漏患者分为两组。分析短期结果。
无造瘘组的美国麻醉医师协会（ASA）评分（ =.009）和急性生理学与慢性健康评估 II（APACHE II）评分（5 分比 10 分； <.001）均低于造瘘组。与造瘘组相比，无造瘘组的重症监护病房入住率（43.2%比 5.8%； =.006）和主要并发症发生率（35.1%比 5.8%； =.015）更高。多变量逻辑回归分析显示，初始手术（ =.001）和 APACHE II 评分（ =.039）是无造瘘的显著预测因素。APACHE II 评分（ =.035）是主要并发症的独立预测因素。最后，受试者工作特征曲线分析显示，APACHE II 评分预测无造瘘的截断值为 7.5。
在本研究中，APACHE II 评分是造瘘的独立预测因素，无造瘘的 APACHE II 评分截断值为 7.5。这些结果需要更大规模和随机研究的验证。特别是，在这种情况下，确定一个特定的 APACHE II 阈值来避免造瘘仍然是一个待解决的问题。
