Tian Weiliang, Zhao Risheng, Xu Xin, Zhao Yunzhao, Luo Shikun, Tao Shen, Yao Zheng
Department of General Surgery, Jinling Hospital, Nanjing, China.
Department of General Surgery, Jiangning Hospital, Nanjing, China.
Front Nutr. 2022 Feb 21;9:708534. doi: 10.3389/fnut.2022.708534. eCollection 2022.
This study is aimed to reveal the role of preoperative chyme reinfusion (CR) in reducing the complications occurring after definitive surgery (DS) for small intestinal enteroatmospheric fistula (EAF).
In this study, from January 2012 to December 2019, the patients with small intestinal EAF and receiving a definitive surgery were recruited. Depending on whether the CR has been performed, these patients were divided into either the CR group or the non-CR group. Then, propensity scores matching (PSM) was used to further divide these patients into the PSM CR group or the PSM none-CR group. The clinical characteristics exhibited by the groups were analyzed, and the effect of preoperative CR was investigated.
A total of 159 patients were finally recruited with 72 patients in the CR group and 87 patients in the non-CR group. The postoperative complications were manifested in a total of 126 cases (79.3%). There were 49 cases in the CR group, and 77 cases in the non-CR group. CR was associated with the occurrence of postoperative complications (multivariate odds ratio [] = 0.289; 95% : 0.123-0.733; = 0.006). After 1:1 PSM, there were 92 patients included. The postoperative complications were observed in 67 out of these 92 patients. There were 26 patients in the PSM CR group, and 41 patients in the PSM non-CR group. CR was associated with postoperative complications (multivariate = 0.161; 95% : 0.040-0.591; = 0.002). In addition, CR played a role in reducing the recurrence of fistula both before (multivariate = 0.382; 95% : 0.174-0.839; = 0.017) and after (multivariate = 0.223; 95% : 0.064-0.983; = 0.034) PSM. In addition, there is a protective factor at play for those patients with postoperative ileus before (multivariate = 0.209; 95% : 0.095-0.437; < 0.001) and after (multivariate = 0.222; 95% : 0.089-0.524; < 0.001) PSM. However, the relationship between CR and incision-related complications was not observed in this study.
Preoperative CR is effective in reducing postoperative complications after definitive surgery was performed for EAF.
本研究旨在揭示术前肠内营养回输（CR）在降低小肠肠-腹壁瘘（EAF）确定性手术（DS）后并发症发生率方面的作用。
本研究纳入了2012年1月至2019年12月期间接受确定性手术的小肠EAF患者。根据是否进行CR，将这些患者分为CR组和非CR组。然后，采用倾向评分匹配（PSM）进一步将这些患者分为PSM CR组和PSM非CR组。分析各组的临床特征，并研究术前CR的效果。
最终共纳入159例患者，CR组72例，非CR组87例。术后并发症共126例（79.3%）。CR组49例，非CR组77例。CR与术后并发症的发生相关（多因素比值比[] = 0.289；95%可信区间：0.123 - 0.733；P = 0.006）。1:1 PSM后，纳入92例患者。这92例患者中观察到67例术后并发症。PSM CR组26例，PSM非CR组41例。CR与术后并发症相关（多因素P = 0.161；95%可信区间：0.040 - 0.591；P = 0.002）。此外，CR在PSM前（多因素P = 0.382；95%可信区间：0.174 - 0.839；P = 0.017）和PSM后（多因素P = 0.223；95%可信区间：0.064 - 0.983；P = 0.034）均对降低瘘复发率有作用。此外，对于术后发生肠梗阻的患者，PSM前（多因素P = 0.209；95%可信区间：0.095 - 0.437；P < 0.001）和PSM后（多因素P = 0.222；95%可信区间：0.089 - 0.524；P < 0.001）均存在保护因素。然而，本研究未观察到CR与切口相关并发症之间的关系。
术前CR对EAF确定性手术后降低术后并发症有效。
