Loop ileostomies in colorectal cancer patients-morbidity and risk factors for nonreversal
Loop ileostomies in colorectal cancer patients-morbidity and risk factors for nonreversal
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DOI：
10.1016/j.jss.2012.08.018
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发表时间：
2012-12-01
影响因子：
2.2
通讯作者：
Angenete, Eva
中科院分区：
文献类型：
--
作者：
Gessler, Bodil;Haglind, Eva;Angenete, Eva
背景：在结直肠癌患者中，回肠袢造口术用于保护吻合口、并发症后的挽救手术以及作为姑息措施。本研究的目的是确定回肠造口术的并发症、逆转时间以及未闭合或永久性造口的危险因素。 材料和方法：对 2007 年 1 月 1 日至 2010 年 2 月 28 日在瑞典西约塔兰地区四家医院连续接受回肠造口术并在初次手术时诊断为结直肠癌的患者进行回顾性研究。记录了人口统计学、索引手术期间的事件、与回肠造口术和技术相关的并发症以及闭合期间的并发症。结果：共有 262 名患者接受了回肠环造口术。 15% 的患者在紧急手术期间进行了髂环切开术。 43% 的人患有与回肠造口术相关的并发症；最常见的是大量排出和造口排出泄漏。关闭后发病率很高，达 28%，死亡率为 1%。 86% 的患者关闭了造口，中位时间为 178 (3-700) 天。不可逆转的危险因素是索引手术的术后并发症和晚期癌症疾病。 11% 接受了二次造口，在研究结束时，23% 接受了永久性造口。结论：与回肠袢造口术和回肠袢造口闭合相关的发病率相当高。五分之一的患者将有永久性造口，我们的结论是，对于患有晚期疾病的急诊患者，如果可能的话，应选择另一种类型的造口，以降低发病率。 (C) 2012 Elsevier Inc. 保留所有权利。
Background: In colorectal cancer patients, loop ileostomies are used to protect an anastomosis, in salvage surgery after a complication, and as a palliative measure. The aim of this study was to identify complications to the ileostomy, time until reversal, and risk factors for nonclosure or a permanent stoma.Material and methods: Consecutive patients who received a loop ileostomy with the diagnosis of colorectal cancer at index surgery in four hospitals in Region Vastra Gotaland, Sweden, from January 1, 2007 until February 28, 2010 were retrospectively studied. Demography, events during index surgery, complications related to the ileostomy and technique, and complications during closure were registered.Results: A total of 262 patients received a loop ileostomy. Loop iliostomies were constructed during emergency surgery in 15% of patients. Forty-three percent had complications related to the ileostomy; most common were high-volume output and leakage of stomal output. Morbidity after closure was high, at 28%, and mortality was 1%. Eighty-six percent had their stoma closed, median time 178 (3-700) d. Risk factors for nonreversal were postoperative complications to index surgery and advanced cancer disease. Eleven percent received a secondary stoma, and at the end of the study 23% had a permanent stoma.Conclusions: The morbidity related to loop ileostomies and loop ileostomy closure is considerable. One in five patients will have a permanent stoma, and our conclusion is that for emergency patients with advanced disease another type of stoma should be chosen, if possible, to reduce the morbidity. (C) 2012 Elsevier Inc. All rights reserved.