Ziv Y, Church J M, Fazio V W, King T M, Lavery I C
Department of Colorectal Surgery, The Cleveland Clinic Foundation, Ohio, USA.
Dis Colon Rectum. 1996 May;39(5):504-8. doi: 10.1007/BF02058701.
Long-term steroid therapy predisposes to postsurgical complications, especially in patients with inflammatory bowel disease.
This study was undertaken to determine incidence of early septic complications after ileal pouch-anal anastomosis (IPAA) in patients who are undergoing prolonged steroid therapy.
We reviewed charts of 692 patients undergoing restorative proctocolectomy and IPAA to treat ulcerative colitis. Incidence of early (within 30 days) septic complications and sepsis-related reoperations, in patients who were having high-dose (>20 mg of prednisone per day) and low-dose steroid therapy (<20 mg of prednisone per day) for more than one month before surgery, was compared with patients who were not receiving steroid therapy. Follow-up included an annual questionnaire and physical examination.
Patients without steroid dose data recorded were excluded (n = 21). Of the 671 remaining patients, 310 received no steroids, 169 received low-dose steroids, and 192 received high-dose steroids. These three groups were similar in gender composition, age at surgery, types of anastomosis (stapled or handsewn), and incidence of diabetes mellitus, peripheral vascular disease, and obesity. Early septic complications were found in 18 (6 percent), 14 (8 percent), and 12 (6 percent) patients without steroid therapy, those having low-dose steroid therapy, and those having high-dose steroid therapy (P = 0.57), respectively. Sepsis- related reoperation rate (P = 0.73) and number of sepsis-related pouch excisions (P = 0.79) did not differ between groups. In patients undergoing IPAA without ileostomy, early septic complications were found in one (3.8 percent), two (20 percent), and five (50 percent) patients without steroid treatment, low-dose steroid therapy, and high-dose steroid therapy (P = 0.004), respectively.
In patients who are undergoing IPAA with diversion for ulcerative colitis, prolonged systemic steroid therapy before surgery is not associated with increased septic complications.
长期使用类固醇疗法易引发术后并发症，尤其是在炎症性肠病患者中。
本研究旨在确定接受长期类固醇治疗的患者在回肠储袋肛管吻合术（IPAA）后早期感染性并发症的发生率。
我们回顾了692例行恢复性直肠结肠切除术和IPAA治疗溃疡性结肠炎患者的病历。将术前接受高剂量（>20毫克泼尼松/天）和低剂量类固醇治疗（<20毫克泼尼松/天）超过1个月的患者与未接受类固醇治疗的患者相比，比较早期（30天内）感染性并发症和脓毒症相关再次手术的发生率。随访包括年度问卷调查和体格检查。
排除未记录类固醇剂量数据的患者（n = 21）。在其余671例患者中，310例未接受类固醇治疗，169例接受低剂量类固醇治疗，192例接受高剂量类固醇治疗。这三组在性别构成、手术年龄、吻合类型（吻合器或手工缝合）以及糖尿病、外周血管疾病和肥胖症的发生率方面相似。未接受类固醇治疗、接受低剂量类固醇治疗和接受高剂量类固醇治疗的患者中，早期感染性并发症分别见于18例（6%）、14例（8%）和12例（6%）（P = 0.57）。脓毒症相关再次手术率（P = 0.73）和脓毒症相关储袋切除数量（P = 0.79）在各组之间无差异。在未行回肠造口术的IPAA患者中，未接受类固醇治疗、接受低剂量类固醇治疗和接受高剂量类固醇治疗的患者中，早期感染性并发症分别见于1例（3.8%）、2例（20%）和5例（50%）（P = 0.004）。
在因溃疡性结肠炎行IPAA并进行转流的患者中，术前长期全身使用类固醇疗法与感染性并发症增加无关。
