Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Sorbonne Université, Paris, France.
HeKA, Inria, Paris, France.
Colorectal Dis. 2024 Jun;26(6):1203-1213. doi: 10.1111/codi.17020. Epub 2024 May 16.
Some patients with inflammatory bowel disease (IBD) require subtotal colectomy (STC) with ileostomy. The recent literature reports a significant number of patients who do not undergo subsequent surgery and are resigned to living with a definitive stoma. The aim of this work was to analyse the rate of definitive stoma and the cumulative incidence of secondary reconstructive surgery after STC for IBD in a large national cohort study.
A national retrospective study (2013-2021) was conducted on prospectively collected data from the French Medical Information System Database (PMSI). All patients undergoing STC in France were included. The association between definitive stoma and potential risk factors was studied using univariate and multivariate analyses.
A total of 1860 patients were included (age 45 ± 9 years; median follow-up 30 months). Of these, 77% (n = 1442) presented with ulcerative colitis. Mortality and morbidity at 90 days after STC were 5% (n = 100) and 47% (n = 868), respectively. Reconstructive surgery was identified in 1255 patients (67%) at a mean interval of 7 months from STC. Seveny-four per cent (n = 932) underwent a completion proctectomy with ileal pouch anal anastomosis and 26% (n = 323) an ileorectal anastomosis. Six hundred and five (33%) patients with a definitive stoma had an abdominoperineal resection (n = 114; 19%) or did not have any further surgical procedure (n = 491; 81%). Independent risk factors for definitive stoma identified in multivariate analysis were older age, Crohn's disease, colorectal neoplasia, postoperative complication after STC, laparotomy and a low-volume hospital.
We found that 33% of patients undergoing STC with ileostomy for IBD had definitive stoma. Modifiable risk factors for definitive stoma were laparotomy and a low-volume hospital.
一些炎症性肠病（IBD）患者需要接受次全结肠切除术（STC）加回肠造口术。最近的文献报道了相当数量的患者不接受后续手术，而选择永久性造口。本研究旨在通过一项大型全国队列研究，分析 IBD 患者接受 STC 后永久性造口的发生率和继发性重建手术的累积发生率。
这是一项在法国医疗信息系统数据库（PMSI）中前瞻性收集数据的全国性回顾性研究（2013-2021 年）。所有在法国接受 STC 的患者均纳入研究。采用单因素和多因素分析方法研究永久性造口与潜在危险因素之间的关系。
共纳入 1860 例患者（年龄 45±9 岁；中位随访时间 30 个月）。其中，77%（n=1442）为溃疡性结肠炎。STC 后 90 天的死亡率和发病率分别为 5%（n=100）和 47%（n=868）。1255 例患者（67%）在 STC 后平均 7 个月行重建手术。74%（n=932）行完成性直肠结肠切除加回肠袋肛管吻合术，26%（n=323）行回肠直肠吻合术。605 例（33%）有永久性造口的患者行腹会阴切除术（n=114；19%）或未行任何进一步手术（n=491；81%）。多因素分析确定的永久性造口的独立危险因素包括年龄较大、克罗恩病、结直肠肿瘤、STC 后术后并发症、剖腹手术和低容量医院。
我们发现，接受回肠造口术的 IBD 患者中有 33%行永久性造口。可改变的永久性造口危险因素是剖腹手术和低容量医院。
