Pan Pradyumna
Ashish Hospital and Research Centre, Pediatric Surgery Unit, Jabalpur, Madhya Pradesh, India.
J Indian Assoc Pediatr Surg. 2022 Mar-Apr;27(2):204-208. doi: 10.4103/jiaps.JIAPS_369_20. Epub 2022 Mar 1.
The aim of this study is to determine the surgical outcome of ileostomy closure at low body weight (<1500 g) and to find any differences in complications and growth of infants whose ileostomy was reversed early (4-6 weeks) versus late (8-10 weeks).
A prospective comparative study was conducted on patients who underwent ileostomy reversal created for necrotizing enterocolitis from January 2017 to December 2019. The patients were divided into two groups: group 1 (early ileostomy closure) between 4 and 6 weeks and Group 2 (late closure) between 8 and 10 weeks. The primary outcome was expressed as the presence of anastomotic leak, obstruction, perforation, wound infection, sepsis, and death.
A cohort of 31 patients with 16 patients in Group 1 and 15 in Group 2 were studied. The mean duration between ostomy creation and reversal was 5.1 ± 0.63 weeks in Group 1 and 8.9 ± 0.66 weeks in Group 2. The mean weight at reversal was 1435.5 ± 163.8 g for patients in Group 1 and 1405 ± 99.93 g for patients in Group 2. Weight gain at 90 days in Group 1 was 895 ± 85.2 g and in Group 2 was 455 ± 34.6 g, which was statistically significant ( < 0.00001). Parenteral nutrition, ability to reach full enteral nutrition, and total ventilator days, mortality rate, and complications were not statistically different between the groups. The overall survival rate was 87.27%.
Ileostomy reversal at a lower weight and within 6 weeks was not associated with an increased risk of complications. Early stoma reversal may help in weight gain.
本研究旨在确定低体重（<1500克）患儿回肠造口关闭术的手术结果，并找出早期（4 - 6周）与晚期（8 - 10周）回肠造口还纳的婴儿在并发症和生长方面的差异。
对2017年1月至2019年12月因坏死性小肠结肠炎而行回肠造口还纳术的患者进行前瞻性对照研究。患者分为两组：第1组（早期回肠造口关闭）在4至6周，第2组（晚期关闭）在8至10周。主要结局指标为吻合口漏、梗阻、穿孔、伤口感染、脓毒症和死亡情况。
共研究了31例患者，其中第1组16例，第2组15例。第1组造口建立至还纳的平均时间为5.1±0.63周，第2组为8.9±0.66周。第1组患者还纳时的平均体重为1435.5±163.8克，第2组为1405±99.93克。第1组90天时体重增加895±85.2克，第2组为455±34.6克，差异有统计学意义（<0.00001）。两组在肠外营养、达到完全肠内营养的能力、总通气天数、死亡率和并发症方面无统计学差异。总体生存率为87.27%。
在较低体重且6周内进行回肠造口还纳术与并发症风险增加无关。早期造口还纳可能有助于体重增加。
