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2018, vol. 75, br. 8, str. 780-786
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Prolongirani postoperativni ileus posle elektivne kolorektalne hirurgije zbog karcinoma
Prolonged postoperative ileus after elective colorectal cancer surgery
aKlinički centar Niš, Klinika za opštu hirurgiju bKlinički centar Niš, Klinika za opštu hirurgiju + Univerzitet u Nišu, Medicinski fakultet
e-adresa: milica20@yahoo.com
Sažetak
Uvod/Cilj. Postoperativni ileus je česta i frustrirajuća pojava i za bolesnike i za hirurge posle abdominalnih hirurških intervencija. Osim kliničkog, važan je i ekonomski aspekt postoperativnog ileusa. Cilj rada bila je analiza pojave postoperativnog ileusa posle elektivnih kolorektalnih operacija zbog karcinoma i njegov uticaj na rani postoperativni ishod. Metode. Studijom su bili obuhvaćeni bolesnici životnog doba od 18 i više godina, lečeni od juna 2015. do februara 2016. godine, kod kojih je bila planirana kolorektalna resekcija zbog karcinoma. Isključujući kriterijumi bili su metastatska bolest, prethodna hemio- i zračna terapija i nekurativna resekcija. Studija je trajala do 30 dana posle operacije. Pojava prolongiranog postoperativnog ileusa, utvrđenog prema strogoj definiciji, postavljena je kao krajnji cilj, a ispitivan je i njegov uticaj na druge parametre ishoda lečenja kao što su: postoperativne komplikacije, infekcija na mestu operativnog rada, dehiscencija anastomoze, reoperacije, mortalitet i trajanje hospitalizacije. Rezultati. Prospektivnom studijom obuhvaćena su 103 bolesnika, 64 (37,9%) muškarca i 39 (62,1%) žena, prosečne starosti 66 godina. Prolongirani postoperativni ileus se javio kod 12 (11,3%) bolesnika. Trećina bolesnika imala je neki tip infekcije na mestu operativnog rada, dok je stopa komplikacija iznosila 47,6%. Ukupno 10 (9,7%) bolesnika je reoperisano. Upoređivanjem grupe sa i bez prolongiranog postoperativnog ileusa nisu uočene statistički značajne razlike u stopama hirurških infekcija i dehiscencija anastomoze. Utvrdjena je statistički značajna razlika u pogledu komplikacija (_2 = 34.966; p < 0.001), komplikacija III stepena (_2 = 23.43; p < 0.001) i reoperacija (_2 = 15.724; p < 0.001). Bolesnici koji su razvili prolongirani postoperativni ileus imali su statistički značajno duži period hospitalizacije posle operacije (Z = 2.291, p = 0.022) kao i duže ukupno trajanje hospitalizacije (Z = 2.377, p = 0.015). Prema regresionom modelu prolongirani postoperativni ileus predstavlja faktor rizika za reoperaciju (OR = 12.286; p = 0,001). Zaključak. Mada ne predstavlja komplikaciju koja neposredno ugrožava život, prolongirani postoperativni ileus utiče na oporavak, produžava vreme bolničkog lečenja i doprinosi lošem ishodu hirurškog lečenja.
Abstract
Background/Aim. Postoperative ileus is a frequent and frustrating occurrence for both, patients and surgeons after abdominal surgery. Besides clinical importance of postoperative ileus, its economic aspect is also important. The aim of this prospective study was to analyze development of prolonged postoperative ileus after elective colorectal surgery for cancer and its impact on early postoperative outcome. Methods. This prospective study included all eligible patients, 18 years or older, scheduled for open colorectal resection for cancer from June, 2015 to February, 2016. Patients with metastatic disease, prior hemoirradiation or any resection other then curative were excluded. The study duration was up to 30 days postoperatively. Primary outcome measure was development of prolonged postoperative ileus according to strict definition. The impact of prolonged postoperative ileus on other outcome measures such as postoperative complications, surgical site infections, anastomotic leakage, reoperations, mortality and length of hospital stay were of great interest, too. Results. This prospective study included 103 patients, 64 (37.9%) men and 39 (62.1%) women, mean age 66 years. Prolonged postoperative ileus developed in 12 (11.3%) patients. One third of the patients had some type of surgical site infection, while 47.6% had complications. Ten (9.7%) patients required reoperation. Comparing the group of patients with prolonged postoperative ileus with those without, there were no statistically significant differences in rates of surgical site infection and anastomotic leakage. There was statistically significant difference in terms of complications (_2 = 34.966; p < 0.001), complications grade III (_2 = 23.43; p < 0.001) and reoperations (_2 = 15.724; p <0.001). Patients who developed prolonged postoperative ileus had statistically significant longer postoperative hospital stay (Z = 2.291, p = 0.022) and longer total length of hospital stay (Z = 2.377, p = 0.015). According to regression analyzes prolonged postoperative ileus represents a risk factor for reoperations [odds ratio (OR) = 12.286; p = 0.001]. Conclusion. Prolonged postoperative ileus, although not life-threatening complication effects recovery, increases length of hospital stay and contributes to poor surgical outcome.
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