- 期刊
Surgical Outcome of Stoma Closure in IBD Surgery
發炎性腸道疾病手術中腸造口關閉之預後
摘要
Purpose. Astomais often performed in IBD surgery. However, complications after stoma creation, stoma closure and permanent stoma can be challenging for both IBD patients and surgeons. We evaluated the surgical outcome of stoma closure in IBD surgery to aid the doctors better understanding of making the stoma to improve the benefits of surgery treatment. Methods. We enrolled IBD patients who underwent surgery between December 2001 and October 2019 at our department. Preoperative evaluation, surgical indications, surgical type, and stoma-related complications, timing of stoma closure, causes for delayed stoma closure and permanent stoma were analyzed. Results. Crohn's disease patients had significantly lower BMI (p = 0.02), higher chance of body weight loss ＞ 5% (p = 0.046), higher nutritional risk before surgery (p ＜ 0.001), previous bowel surgery history (p = 0.01), and biological agent use (p = 0.011). A significant difference was also noted in primary stoma creation between UC and CD (79.2% vs. 25%, p = 0.002). The stoma closure rate was 57.8% for UC and 42.8% for CD (p = 0.495). Stoma-related Grade III complications were observed in 26.3% of UC cases and 57.1% of CD cases (p = 0.143). Complication of stoma closure was significant lower in UC when compared to CD (0% vs. 33%, p = 0.047). End ileostomy status with disease poor control were the most common etiology for delayed stoma closure or permanent stoma. Conclusion. In order to achieve inflammation control, a stoma is often being created in IBD surgery. However, there's a certain portion of patient suffered from stoma related morbidity, especially in CD. And the incidence of permanent stoma is still high in IBD patients.
並列摘要
目的：為了疾病控制，在發炎性腸道疾病的手術中時常會伴隨腸造口，然而做腸造口時，關閉造口後與永久腸造口等併發症對於患者跟外科醫師皆是一個挑戰。我們分析發炎性腸道疾病病患造口關閉之預後，以幫助外科醫師了解腸造口手術對於發炎性腸道疾病的影響。方法：挑選本院2001年至2019年發炎性腸道疾病的患者，分析術前因子，手術適應症，手術方式，術後併發症。另外也深入探討永久性腸造口的比例與原因。結果：克隆氏症病患，術前有較低的BMI（p=0.02），體重減輕大於5%的比例較高（p=0.046），較高的營養風險（p＜0.001），較多的腸道手術史（p=0.01）以及較多的生物製劑使用（p=0.011）。而且克隆氏症病患在主要手術時一併做腸造口的比例較低（p=0.002）。26.3%的發炎性大腸炎患者與57.1%的克隆氏症病患有發生嚴重腸造口併發症需要開刀處理。57.8%發炎性大腸炎患者與42.8%克隆氏症之病患能接受腸造口關閉。腸造口關閉手術後，只有一位克隆氏症病患因皮腸廔管需在需再次重做腸造口分流。終端迴腸造口伴隨的疾病控制不佳是造口延遲或是無法關閉的最大因素。結論：發炎性腸道疾病的患者，因腸造口產生的併發症不少，特別是克隆氏症克隆氏症病患。而雖然關閉造口時的併發症很少，但是無法關閉的永久性腸造口還是佔有一半左右的比例。