Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.
Am Surg. 2024 Nov;90(11):3054-3060. doi: 10.1177/00031348241260275. Epub 2024 Jun 20.
BACKGROUND: Ileus is a common complication of major abdominal surgery, including colorectal resection. The present study aimed to assess the predictors of ileus after laparoscopic right colectomy for colon cancer. METHODS: This study was a retrospective case-control analysis of a prospective IRB-approved database of patients who underwent laparoscopic right colectomy at the Department of Colorectal Surgery, Cleveland Clinic Florida. Patients who developed ileus after right colectomy were compared to patients without ileus to determine the risk factors of ileus. RESULTS: The present study included 270 patients with a mean age of 68.7 years. Thirty-six patients (13.3%) experienced ileus after laparoscopic right colectomy. The median duration of ileus was 6 days. Factors associated with ileus were age (71.6 vs 68.2 years, = .158), emergency colectomy (11.1% vs 3.9%, = .082), extended hemicolectomy (19.4% vs 6.8%, = .021), green gastrointestinal anastomosis (GIA) 4.8mm staple height cartridge (19% vs 8.1%, = .114), and longer operative time (177.9 vs 160.4 minutes, = .157). The only independent predictor of ileus was extended colectomy (OR: 16.7, = .003). CONCLUSIONS: Increased age, emergency surgery, green GIA cartridge, and longer operative times were associated with ileus, yet the only independent predictor of ileus was extended right hemicolectomy.
背景:肠梗阻是包括结直肠切除在内的大型腹部手术后的常见并发症。本研究旨在评估腹腔镜右半结肠切除术治疗结肠癌后发生肠梗阻的预测因素。
方法:本研究是对克利夫兰诊所佛罗里达州结直肠外科部门进行的腹腔镜右半结肠切除术患者前瞻性 IRB 批准数据库的回顾性病例对照分析。将右半结肠切除术后发生肠梗阻的患者与未发生肠梗阻的患者进行比较,以确定肠梗阻的危险因素。
结果:本研究共纳入 270 例患者,平均年龄为 68.7 岁。36 例(13.3%)患者在腹腔镜右半结肠切除术后发生肠梗阻。肠梗阻的中位持续时间为 6 天。与肠梗阻相关的因素包括年龄(71.6 岁比 68.2 岁, =.158)、急诊手术(11.1%比 3.9%, =.082)、扩大半结肠切除术(19.4%比 6.8%, =.021)、绿色胃肠吻合术(GIA)4.8mm 钉高卡匣(19%比 8.1%, =.114)和较长的手术时间(177.9 分钟比 160.4 分钟, =.157)。肠梗阻的唯一独立预测因素是扩大的结肠切除术(OR:16.7, =.003)。
结论:年龄增加、急诊手术、绿色 GIA 卡匣和较长的手术时间与肠梗阻相关,但肠梗阻的唯一独立预测因素是扩大的右半结肠切除术。
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