Post S, Herfarth C, Schumacher H, Golling M, Schürmann G, Timmermanns G
Department of Surgery, University of Heidelberg, Germany.
Br J Surg. 1995 Dec;82(12):1629-33. doi: 10.1002/bjs.1800821213.
This study involved 746 patients with Crohn's disease treated surgically within a 13-year interval in whom 227 stomas (159 primary, 68 secondary) were created. The main indication (64 per cent) for primary stoma was severe perianal or genital fistulous disease. Revisional surgery for stomal complications was more common following colostomy than ileostomy (31 versus 5 per cent, P < 0.01). Twenty years after the first symptoms of Crohn's disease the cumulative risks of receiving any stoma or a permanent stoma were 41 and 14 per cent respectively. Four parameters were shown by proportional hazards analysis to be independently associated with the risk for any stoma as well as a permanent one; increased risk coincided with rectal inflammation, perianal fistula or abscess, and absence of small intestinal involvement. In addition, long-standing symptomatic disease before the first surgical intervention reduced the risk of a permanent stoma. The long-term chances of closure following temporary stoma were 75 per cent when used for anastomotic protection or avoidance, 79 per cent after postoperative complications, and 40 per cent for perianal or genital fistulas or for rectal inflammation or stenosis. Rectal disease and perianal fistula were the only independent predictors of a low possibility of stoma closure during follow-up.
本研究纳入了746例在13年间接受手术治疗的克罗恩病患者，共造口227个（159个一期造口，68个二期造口）。一期造口的主要指征（64%）是严重的肛周或生殖器瘘管病。结肠造口术后因造口并发症进行的修复手术比回肠造口术更常见（31%对5%，P<0.01）。克罗恩病首发症状出现20年后，接受任何造口或永久性造口的累积风险分别为41%和14%。多因素分析显示，有4个参数与任何造口以及永久性造口的风险独立相关；风险增加与直肠炎症、肛周瘘管或脓肿以及无小肠受累情况同时出现。此外，首次手术干预前长期存在症状性疾病会降低永久性造口的风险。临时造口用于吻合口保护或避免吻合口相关情况时，长期闭合的几率为75%；用于术后并发症时为79%；用于肛周或生殖器瘘管或直肠炎症或狭窄时为40%。直肠疾病和肛周瘘管是随访期间造口闭合可能性低的唯一独立预测因素。
