Early Feeding and Shortened Hospital Stay after Colostomy Takedown in Patients with Imperforate Anus

無肛症病患經大腸造口復原手術後早期餵食能縮短住院天數

陳肇真(Chau-Jing Chen) ； 莊仁賓(Jen-Pin Chuang)

《Formosan Journal of Surgery》 43卷3期 (2010/06) Pp. 129-134

https://doi.org/10.29833/FJS.201006.0003

摘要

目的：此研究回顧過去15年來的94位無肛症患者，分析其經大腸造口復原手術後最佳的餵食方案與住院計畫。
方法：本篇作者從西元1988年6月至2003年8月共治療了145位無肛症患者，其中有94位患者接受了三階段手術（大腸造口，後方矢狀肛門直腸整形術以及大腸造口復原手術）。傳統上，病患於術後第二天至第三天開始接受餵食，於術後第五天至第六天出院(n=10)。西元1991年，作者開始新的術後照顧方案，病患於術後第一天即開始接受餵食，於術後第二天出院(n=21)。到了西元1994年，作者開始另一個更積極的術後照顧方案，病患於術後六小時即開始接受餵食，然而，其中有一名病患出現腸吻合處滲漏的情形，此一病患經過禁食三天後，腸吻合處滲漏獲得解決。因此，我們的餵食方案恢復回西元1991年的版本，自西元1995年後，又增加了59位患者進入西元1991年版本的方案。
結果：總共有80位病患接受了西元1991年版本的術後照顧方案，病患於平均術後20.2小時（17.4-41.5小時）即開始接受餵食，術後平均住院天數爲1.9天（1.7-3.2天）。有三位患者出現輕微併發症，但經過保守治療後皆順利復原。共有4位病患接受了西元1994年版本的術後照顧方案，其中有一名病患出現腸吻合處滲漏的情形。
結論：針對無肛症患者經大腸造口復原手術後，我們的術後第一天即開始接受餵食，於術後第二天出院的計畫是安全且有效的。

並列摘要

Objective: This study reviewed 15 years of experience with 94 patients to identify an optimal feeding protocol and hospitalization plan for patients with imperforate anus who underwent colostomy takedown.
Methods: The authors treated 145 patients with imperforate anus from June 1988 to August 2003. Among them, 94 underwent a 3-stage operation (colostomy, posterior sagittal anorectoplasty, and colostomy takedown). Traditionally, patients started feeding on the 2(superscript nd) or 3(superscript rd) postoperative day (POD) and went home on the 5(superscript th) or 6(superscript th) POD (n=10). In 1991, the authors adopted a protocol in which patients received feeding on the 1(superscript st) POD and were discharged on the 2(superscript nd) POD (n=21). Then, in 1994, a more aggressive protocol permitted feeding 6 hours after colostomy takedown. However, one patient suffered an anastomotic leak, which subsided three days later after abstinence from feeding. Thus the 1(superscript st) POD feeding protocol was resumed in 1995 and 59 more patients were added to the 1991 program.
Results: Of the 80 patients following the 1991 protocol, feeding started at 20.2 hours (range 17.4-41.5), and the mean postoperative hospital stay was 1.9 days (range 1.7-3.2). Three patients encountered minor complications but recovered after conservative treatment. Of the 4 patients following the 1994 protocol, one suffered anastomotic leakage.
Conclusion: Our 1(superscript st) POD feeding and 2(superscript nd) POD discharge plan is safe and efficient for patients with imperforate anus who undergo colostomy takedown.

並列關鍵字

colostomy takedown ； feeding protocol ； imperforate anus