恢复性直肠切除术和回肠袋肛门吻合术后，分流回肠造口术对功能效果和生活质量的影响。

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2024-10-03 DOI:10.1111/codi.17196

Gregory Martin, Thibault Voron, Maxime Collard, Lauren O'Connell, Alexandre Challine, Najim Chafai, Jeremie H. Lefèvre, Yann Parc

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引用次数: 0

摘要

目的：经过选择的患者可以在恢复性直肠结肠切除术（RPC）后省略憩室回肠造口术（DS）。正如在直肠切除术后的患者身上所证实的那样，省略该手术可改善功能结果和生活质量（QoL）。本研究旨在报告回肠造口术对回肠袋-肛门吻合术（IPAA）后功能预后和生活质量的影响：这是一项回顾性研究，包括所有因 RPC 而接受 IPAA 手术的患者（2015-2020 年）。功能结果通过有效评分（LARS、Wexner、Öresland、肛门袋功能评分[PFS]和回肠肛门袋综合征严重程度评分[IPSS]）进行评估。总体健康相关 QoL 采用 SF-36 进行评估。我们还分析了人口统计学特征、发病率、功能结果与 QoL 之间的相关性：在 179 名符合条件的患者中，有 150 人（84%）做出了回应：结果：在 179 名符合条件的患者中，150 人（84%）做出了回应：S-（无造口 = 78；52%）和 S+（有造口 = 72；48%）。总发病率和吻合口漏率分别为 46% 和 9.3%，两组之间无差异。S- 组和 S+ 组的功能评分中值相当：LARS评分为18[12.5-31]分对18[11-31]分，P=0.48；Wexner评分为9[7-11]分对9[7-12]分，P=0.23；Öresland评分为6[3-13]分对8[5-11]分，P=0.22；PFS评分为6[3-13]分对6.8[4-12]分，P=0.174；IPSS评分为40[35-45]分对46[42-51]分，P=0.045。两组患者的 SF-36 总分相当，在八个特定健康维度上没有任何差异。经过倾向得分匹配后，两组的所有得分结果仍具有可比性。线性回归发现，所有 QoL 领域与所有功能性评分之间均存在显著相关性（p 结论：IPAA 的 DS 不会改变所有 QoL 领域和功能性评分：IPAA的DS治疗不会改变功能结果或QoL，对于选定的患者可以省略。

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Impact of diverting ileostomy on functional outcome and quality of life after restorative proctocolectomy and ileal pouch anal anastomosis

Aim

Diverting ileostomy (DS) after restorative proctocolectomy (RPC) can be omitted in selected patients. Its omission could improve functional outcomes and quality of life (QoL), as has been demonstrated in patients after proctectomy. The aim of this study was to report the impact of diverting ileostomy on functional outcomes and QoL after ileal pouch-anal anastomosis (IPAA).

Methods

This was a retrospective study including all patients operated (2015–2020) for RPC with IPAA. Functional outcome was evaluated by validated scores (LARS, Wexner, Öresland, pouch functional score [PFS] and the ileoanal pouch syndrome severity [IPSS] score). Global health-related QoL was evaluated with the SF-36. We also analysed demographic characteristics, morbidity, correlation between functional outcomes and QoL.

Results

Among 179 eligible patients, 150 responded (84%): S− (no stoma = 78; 52%) and S+ (had stoma = 72; 48%). Overall morbidity and anastomotic leak rates were 46% and 9.3%, respectively without difference between the groups. Medians for the functional scores were comparable between the S− and S+ group, respectively: 18 [12.5–31] versus 18 [11–31], p = 0.48 for LARS; 9 [7–11] versus 9 [7–12], p = 0.23 for Wexner's score; 6 [3–13] versus 8 [5–11], p = 0.22 for Öresland's score, 6 [3–13] versus 6.8 [4–12], p = 0.174 for PFS score, and 40 [35–45] versus 46 [42–51], p = 0.045 for IPSS score. The SF-36 summary score was comparable between the two groups without any difference in eight specific health dimensions. After propensity score matching, results were still comparable between the two groups for all scores. Linear regression found a significant correlation between all QoL domains and all functional scores (p < 0.001).

Conclusion

DS for IPAA does not alter either functional outcomes or QoL and can be omitted in selected patients.

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.