Western Sussex Hospitals NHS Trust, Worthing, UK.
General Surgical Department, St Richards Hospital, Chichester, UK.
Colorectal Dis. 2022 Nov;24(11):1390-1396. doi: 10.1111/codi.16207. Epub 2022 Jun 16.
Percutaneous endoscopic colostomy (PEC) represents an important intervention in specific patients. Limited data currently exist. We present the largest recorded study of patients undergoing PEC.
Retrospective analysis of consultant logbooks highlighted all patients from 1997 to 2020. Two independent reviewers assessed records. Parameters measured were age, sex, indication, number of sites, complications, mortality and survival. Three subgroups were identified: recurrent sigmoid volvulus (RSV), pseudo-obstruction and neurogenic. ANOVA, chi-squared and Fischer's exact tests were utilized; Kaplan-Meier curves estimated survival and the log-rank test was applied. A p value of <0.05 was considered statistically significant.
Ninety-six PEC insertions were done on 91 patients (five reinsertions). There were 66 men (69%) and the mean age was 73.1 years (interquartile range 23). The indications were RSV n = 72, pseudo-obstruction n = 13, neurogenic n = 11. The 30-day complication rate was overall n = 27 (28%), RSV n = 23, pseudo-obstruction n = 4. Nine patients leaked (9.9%) (eight RSV, one pseudo-obstruction), of whom five died. 90-day mortality was 14.6% (14 patients), 18.5% (13/72) for RSV, 7.7% (1/13) for pseudo-obstruction. Overall recurrence following PEC was 10.4%. The median follow-up was 25 months (interquartile range 4.6-62.2 months). At 3, 5 and 10 years survival was 46%, 34% and 26% for RSV, 70%, 55% and 15% for pseudo-obstruction and 91%, 91% and 81% for neurogenic respectively.
Recurrent sigmoid volvulus and pseudo-obstruction patients undergoing PEC compared to neurogenic patients have poorer outcomes with higher complication rates and shorter life expectancy. We advocate that high volume specialist units undertake PEC. The significant associated risks of PEC require careful consideration when determining patient suitability. Utilizing risk stratification scores may help guide shared decision making between patients, relatives and clinicians.
经皮内镜造口术（PEC）是特定患者的重要干预措施。目前相关数据有限。我们报告了接受 PEC 治疗的患者数量最多的记录研究。
对 1997 年至 2020 年顾问日志记录进行回顾性分析，两位独立的审查员评估了记录。测量的参数包括年龄、性别、适应证、造口部位数量、并发症、死亡率和存活率。确定了三个亚组：复发性乙状结肠扭转（RSV）、假性肠梗阻和神经性。采用方差分析、卡方检验和 Fisher 精确检验；Kaplan-Meier 曲线估计生存率，对数秩检验用于分析。p 值<0.05 被认为具有统计学意义。
91 名患者进行了 96 次 PEC 插入术（5 次再次插入）。其中 66 名男性（69%），平均年龄为 73.1 岁（四分位距 23）。适应证为 RSV n=72、假性肠梗阻 n=13、神经性 n=11。30 天并发症发生率总体为 n=27（28%），RSV n=23、假性肠梗阻 n=4。9 名患者漏液（9.9%）（8 例 RSV，1 例假性肠梗阻），其中 5 例死亡。90 天死亡率为 14.6%（14 例），RSV 为 18.5%（13/72），假性肠梗阻为 7.7%（1/13）。PEC 后总体复发率为 10.4%。中位随访时间为 25 个月（四分位距 4.6-62.2 个月）。RSV 组的 3、5 和 10 年生存率分别为 46%、34%和 26%，假性肠梗阻组为 70%、55%和 15%，神经性组为 91%、91%和 81%。
与神经性患者相比，接受 PEC 的复发性乙状结肠扭转和假性肠梗阻患者的并发症发生率更高，预后更差，预期寿命更短。我们主张高容量专科单位进行 PEC。当确定患者的适宜性时，需要仔细考虑 PEC 带来的显著相关风险。利用风险分层评分可能有助于指导患者、家属和临床医生之间的共同决策。
