FACTORS INFLUENCING THE SAFETY OF COLOSTOMY CLOSURE IN THE ELDERLY
FACTORS INFLUENCING THE SAFETY OF COLOSTOMY CLOSURE IN THE ELDERLY
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DOI：
10.1006/jsre.1994.1147
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发表时间：
1994-08-01
影响因子：
2.2
通讯作者：
HUNTER, GC
中科院分区：
文献类型：
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作者：
WONG, RW;RAPPAPORT, WD;HUNTER, GC
虽然结肠造口闭合是一种常见的外科手术，但仍有人担心可能会误判伴随的风险，特别是在老年人中。本研究的目的是评估进行结肠造口闭合的安全性，并确定可能影响70岁以上患者发病率和死亡率的因素。307例患者（178例男性，129例女性）在5年内接受了结肠造口闭合。平均年龄为52岁，84例（27%）患者年龄≥ 70岁。结肠造口术的适应症包括憩室炎，115例（38%）;恶性肿瘤，47例（15%）;穿孔35例（11%）;创伤，34例（11%）;先天性异常，26例（8%）;梗阻，13例（4%）;出血，6例（2%）;结肠膀胱瘘，6例（2%）;息肉，2例（0.7%）;和其他，23例（8%）。193例（63%）患者行末端结肠造口术，其余114例（37%）患者行横袢结肠造口术。无死亡病例。27例（9%）患者发生并发症：17例与结肠造口闭合直接相关（8例伤口感染，3例腹腔内脓肿，3例小肠梗阻，2例吻合口狭窄和1例吻合口瘘），10例为非手术性。统计学上与发病率增加相关的危险因素包括年龄>70岁（13%对5%），末端与袢式结肠造口术（10%对2%），手术时间>2小时，估计失血量大于或等于500 ml（P < 0.05）。阿萨分级仅预测70岁以上患者的术后并发症。我们的结论是，虽然结肠造口关闭可以进行无死亡率，增加发病率与此相关的70岁或以上的患者需要仔细的术前评估。(C)1994年出版社出版。
Although colostomy closure is a commonly performed surgical procedure, there remains concern that the attendant risks may be misjudged, especially in the elderly. The purpose of this study was to evaluate the safety of performing colostomy closure and to define the factors that may influence morbidity and mortality in patients over the age of 70. Three hundred seven patients (178 males, 129 females) underwent colostomy closure over a 5-year period. The mean age was 52 years and 84 (27%) of the patients were 70 years or older. The indications for colostomy included diverticulitis, 115 (38%); malignancy, 47 (15%); perforation 35 (11%); trauma, 34 (11%); congenital anomalies, 26 (8%); obstruction, 13 (4%); bleeding, 6 (2%); colovesical fistulae, 6 (2%); polyps, 2 (0.7%); and miscellaneous, 23 (8%). An end colostomy was performed in 193 (63%) patients and a transverse loop colostomy in the remaining 114 (37%). There were no deaths. Complications occurred in 27 (9%) patients: 17 were directly related to colostomy closure (8 wound infections, 3 intraabdominal abscesses, 3 small bowel obstructions, 2 anastomotic strictures, and 1 anastomotic leak) while 10 were nonsurgical. Risk factors statistically associated with increased morbidity included age >70 years (13% versus 5%), end versus loop colostomy (10% versus 2%), an operative time >2 hr, and estimated blood loss greater than or equal to 500 ml (P < 0.05). ASA classification was only predicative of postoperative complications in patients over 70 years of age. We conclude that although colostomy closure can be performed without mortality, the increased morbidity associated with this procedure in patients 70 years or older necessitates careful preoperative assessment. (C) 1994 Academic Press, Inc.