穿透性创伤后行结肠吻合术的近端保护性转流造口术可能起不到保护作用：一项配对队列研究。
Proximal protective diverting ostomy following colon anastomosis for penetrating trauma may not be protective: A matched cohort study.
机构信息
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA; Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
出版信息
Am J Surg. 2024 Feb;228:237-241. doi: 10.1016/j.amjsurg.2023.10.026. Epub 2023 Oct 13.
INTRODUCTION
Despite the shift toward liberal primary anastomosis in penetrating colon injuries, some surgeons recommend a protective diverting ostomy (DO) proximal to the anastomosis. This study evaluates the effect of DO on outcomes in patients undergoing colon resection and anastomosis following penetrating trauma.
METHODS
The TQIP database (2013-2018) was queried for penetrating colon injuries undergoing colectomy and anastomosis. Patients receiving DO were propensity matched to patients without diverting ostomy (woDO) (1:3). Outcomes were compared between groups.
RESULTS
After matching, 89 DO patients were analyzed. The DO group had more surgical site infections (32 % vs. 21 %; p < 0.05) and longer hospital stay (20 [13-27] vs. 15 [9-25]; p < 0.05) compared to the woDO group. Mortality and unplanned operations were similar between groups.
CONCLUSIONS
Diverting ostomy after colon resection and anastomosis is associated with increased infectious complications without decreasing unplanned operations or mortality. Its routine role in penetrating colon trauma needs reassessment.
简介
尽管穿透性结肠损伤的治疗方法已转向自由端端吻合术，但仍有部分外科医生建议在吻合术近端行保护性预防性横结肠造口术（DO）。本研究旨在评估 DO 对穿透性创伤后行结肠切除和吻合术患者结局的影响。
方法
通过 TQIP 数据库（2013-2018 年）检索接受结肠切除术和吻合术的穿透性结肠损伤患者。对行 DO 的患者进行倾向评分匹配，以 1:3 的比例与未行 DO（woDO）的患者进行匹配。比较两组患者的结局。
结果
匹配后，共分析了 89 例 DO 患者。DO 组的手术部位感染率（32% vs. 21%；p<0.05）和住院时间（20 [13-27]天 vs. 15 [9-25]天；p<0.05）均长于 woDO 组。两组的死亡率和非计划性手术率相似。
结论
结肠切除和吻合术后行 DO 与感染并发症增加相关，且不能降低非计划性手术率或死亡率。在穿透性结肠外伤中，其常规应用需要重新评估。
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