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回肠袢式造口关闭的时机在并发症方面并非起关键作用——回肠袢式造口清理(LILEO)研究结果

Timing of Loop Ileostomy Closure Does Not Play a Pivotal Role in Terms of Complications-Results of the Liquidation of iLEOstomy (LILEO) Study.

作者信息

Kisielewski Michał, Pisarska-Adamczyk Magdalena, Dowgiałło-Gornowicz Natalia, Nawacki Łukasz, Serednicki Wojciech, Wierdak Mateusz, Wilczek Jerzy, Safiejko Kamil, Juchimiuk Marcin, Domurat Marian, Pierko Jacek, Mucha Mateusz, Fiedorowicz Wojciech, Wysocki Michał, Ladziński Maurycy, Zdrojewski Michał, Sachańbiński Tomasz, Wojewoda Tomasz, Chochla Victoria, Tkaczyński Karol, Jankowski Michał, Wysocki Wojciech M

机构信息

Chair of Surgery of the Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, 30-705 Krakow, Poland.

Department of General and Oncological Surgery, 5th Military Clinical Hospital, 30-901 Krakow, Poland.

出版信息

J Pers Med. 2024 Aug 31;14(9):934. doi: 10.3390/jpm14090934.

Abstract

Loop ileostomy is commonly performed by colorectal and general surgeons to protect newly created large bowel anastomoses. The optimal timing for ileostomy closure remains debatable. Defining the timing associated with the best postoperative outcomes can significantly improve the clinical results for patients undergoing ileostomy closure. The LILEO study was a prospective multicenter cohort study conducted in Poland from October 2022 to December 2023. Full data analysis involved 159 patients from 19 surgical centers. Patients were categorized based on the timing of ileostomy reversal: early (<4 months), standard (4-6 months), and delayed (>6 months). Data on demographics, clinical characteristics, and perioperative outcomes were analyzed for each group separately and compared. No significant differences were observed in length of hospital stay ( = 0.22), overall postoperative complications ( = 0.43), or 30-day reoperation rates ( = 0.28) across the three groups. Additional analysis of Clavien-Dindo complication grades was performed and did not show significant differences in complication severity ( = 0.95), indicating that the timing of ileostomy closure does not significantly impact perioperative complications or hospital stay. Decisions on ileostomy reversal timing should be personalized and should consider individual clinical factors, including the type of adjuvant oncological treatment and the preventive measures performed for common postoperative complications.

摘要

袢式回肠造口术通常由结直肠外科医生和普通外科医生实施,以保护新形成的大肠吻合口。回肠造口关闭的最佳时机仍存在争议。确定与最佳术后结果相关的时机可显著改善接受回肠造口关闭术患者的临床效果。LILEO研究是一项于2022年10月至2023年12月在波兰进行的前瞻性多中心队列研究。完整数据分析纳入了来自19个外科中心的159例患者。患者根据回肠造口还纳的时机进行分类:早期(<4个月)、标准期(4 - 6个月)和延迟期(>6个月)。分别对每组的人口统计学、临床特征和围手术期结果数据进行分析并比较。三组在住院时间(P = 0.22)、总体术后并发症(P = 0.43)或30天再次手术率(P = 0.28)方面未观察到显著差异。对Clavien - Dindo并发症分级进行了额外分析,结果显示并发症严重程度无显著差异(P = 0.95),这表明回肠造口关闭的时机对围手术期并发症或住院时间没有显著影响。回肠造口还纳时机的决策应个性化,并应考虑个体临床因素,包括辅助肿瘤治疗的类型以及针对常见术后并发症采取的预防措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6ba8/11433270/a522d872e0b1/jpm-14-00934-g001.jpg

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