回肠造口术后结直肠肿瘤手术中回肠造口相关肾损伤的术前危险因素。

Preoperative risk factors for ileostomy-associated kidney injury in colorectal tumor surgery following ileostomy formation.

机构信息

Department of Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan.

Department of Colorectal Surgery, Kansai Medical University, Hirakata, Japan.

出版信息

Int J Colorectal Dis. 2024 Oct 14;39(1):160. doi: 10.1007/s00384-024-04732-6.

DOI:10.1007/s00384-024-04732-6

PMID:39397177

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11471691/

Abstract

PURPOSE

Diverting ileostomy is related to postoperative high-output stoma (HOS) leading to kidney injury. The purpose of our study was to clarify the risk factors for ileostomy-associated kidney injury, which is kidney injury starting after the first operation to ileostomy closure after colorectal tumor surgery with diverting ileostomy.

METHODS

Between January 2013 and December 2020, 442 patients who underwent colorectal tumor surgery (cancer, neuroendocrine tumor, and leiomyosarcoma) following diverting ileostomy formation were included. We used the KDIGO (Kidney Disease Improving Global Outcomes) guidelines, which defines the acute kidney injury (AKI) to classify patients with ileostomy-associated kidney injury. The definition of AKI was (i) serum creatinine (sCr) ≥ 0.3 mg/dL or (ii) sCr ≥1.5-fold the preoperative level. Multivariate analyses were performed to identify the independent risk factors for kidney injury.

RESULTS

Kidney injury developed in 99/442 eligible patients (22.4%). Patients in the kidney injury group were older age, male sex, high American Society of Anesthesiologists Physical Status Classification System (ASA-PS) score, hypertension, cardiovascular diseases, diabetes. The preoperative hemoglobin, albumin, prognostic nutritional index (PNI), and creatinine clearance (CCr) were lower, and the maximum wound length was more extended than the non-kidney injury group. The median highest daily stoma output was significantly higher in the kidney injury group. The postoperative white blood cell (WBC) and C-reactive protein (CRP) levels were also high in the kidney injury group. The univariate analysis showed older age, male sex, high ASA-PS score, hypertension, cardiovascular diseases, and diabetes were the risk factors for kidney injury. The multivariate analysis revealed that age 70 or older, ASA-PS III/IV, hypertension, and HOS ≥2000 ml/day were independent risk factors for kidney injury.

CONCLUSIONS

Surgeons should consider diverting colostomy creation for patients with risk factors such as age 70 or older, ASA-PS III/IV, and hypertension.

摘要

目的

回肠造口术与术后高输出肠瘘（HOS）导致的肾损伤有关。本研究旨在阐明与回肠造口术相关的肾损伤的危险因素，即与回肠造口术相关的肾损伤是指在大肠肿瘤手术后形成结肠造口术并进行回肠造口术引流后，直至第一次手术关闭回肠造口术期间发生的肾损伤。

方法

本研究纳入了 2013 年 1 月至 2020 年 12 月期间因形成结肠造口术而接受大肠肿瘤手术（癌症、神经内分泌肿瘤和平滑肌肉瘤）的 442 例患者。我们使用了 KDIGO（肾脏疾病：改善全球预后组织）指南，该指南将急性肾损伤（AKI）定义为患者发生与回肠造口术相关的肾损伤的分类标准。AKI 的定义为（i）血清肌酐（sCr）≥0.3mg/dL 或（ii）sCr 比术前水平升高 1.5 倍。我们进行了多变量分析以确定肾损伤的独立危险因素。

结果

在 442 例符合条件的患者中，99 例（22.4%）发生了肾损伤。与非肾损伤组相比，肾损伤组患者年龄较大、男性、美国麻醉医师协会身体状况分类系统（ASA-PS）评分较高、患有高血压、心血管疾病和糖尿病。肾损伤组患者的术前血红蛋白、白蛋白、预后营养指数（PNI）和肌酐清除率（CCr）较低，最大伤口长度也较长。肾损伤组的每日最高肠瘘输出量中位数明显较高。肾损伤组患者的术后白细胞（WBC）和 C 反应蛋白（CRP）水平也较高。单因素分析显示，年龄较大、男性、ASA-PS 评分较高、患有高血压、心血管疾病和糖尿病是肾损伤的危险因素。多变量分析显示，年龄≥70 岁、ASA-PS III/IV、高血压和 HOS≥2000ml/d 是肾损伤的独立危险因素。