Zhang X, Wang C, Li G, Qiu X, Chen W, Lu J, Xu L, Wu B, Xiao Y, Lin G
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Tech Coloproctol. 2025 May 23;29(1):119. doi: 10.1007/s10151-025-03163-x.
Prolonged postoperative ileus (PPOI) is a common complication following total mesorectal excision. Early detection and prompt intervention are crucial for the treatment of rectal cancer.
We conducted a retrospective study. After applying propensity score matching, we collected and compared the clinical characteristics of 164 patients in both the PPOI group and the non-PPOI group using univariate analysis. Significant factors identified were then evaluated in a multivariable logistic regression analysis. Moreover, we analyzed the clinical features and treatment strategies.
The incidence of PPOI after laparoscopic TME was 18.3% in our trial. Univariate analysis revealed significant differences in several factors between the two groups, including prophylactic anaerobic antibiotic therapy (p < 0.001), preoperative bowel obstruction (p = 0.006), preoperative nutritional support therapy (p < 0.001), and the type of stoma (p < 0.001). However, further multivariable logistic regression analysis indicated that prophylactic anaerobic antibiotic therapy was not an independent risk factor for PPOI. Among the patients who experienced PPOI, the majority, 135 patients (82.3%), presented with Clavien-Dindo grades I-II. Overall, 81.7% and 85.4% of patients received oral probiotics and vancomycin treatment, respectively. Only 48 patients (29.3%) required gastric tube insertion, while 27 patients (16.5%) needed a transnasal ileus tube due to ineffective drug treatment.
Our study suggests that selecting the appropriate preoperative nutritional support strategy and type of stoma is crucial in reducing the incidence of PPOI. When PPOI occurs, a multi-stage treatment protocol may be beneficial for recovery.
术后肠梗阻延长（PPOI）是全直肠系膜切除术后的常见并发症。早期检测和及时干预对直肠癌治疗至关重要。
我们进行了一项回顾性研究。应用倾向得分匹配后，我们收集并比较了PPOI组和非PPOI组164例患者的临床特征，采用单因素分析。然后在多变量逻辑回归分析中评估确定的显著因素。此外，我们分析了临床特征和治疗策略。
在我们的试验中，腹腔镜全直肠系膜切除术后PPOI的发生率为18.3%。单因素分析显示两组在几个因素上存在显著差异，包括预防性厌氧抗生素治疗（p < 0.001）、术前肠梗阻（p = 0.006）、术前营养支持治疗（p < 0.001）和造口类型（p < 0.001）。然而，进一步的多变量逻辑回归分析表明，预防性厌氧抗生素治疗不是PPOI的独立危险因素。在发生PPOI的患者中，大多数（135例，82.3%）表现为Clavien-Dindo I-II级。总体而言，分别有81.7%和85.4%的患者接受了口服益生菌和万古霉素治疗。只有48例患者（29.3%）需要插入胃管，而27例患者（16.5%）因药物治疗无效需要插入鼻空肠管。
我们的研究表明，选择合适的术前营养支持策略和造口类型对降低PPOI的发生率至关重要。当发生PPOI时，多阶段治疗方案可能有利于恢复。
