예방적 회장루 복원술과 치료적 회장루 복원술의 합병증 발생비교

이동현(Dong-hyoun Lee),윤정아(Jung-a Yun),정경욱(Kyung Uk Jung),조용범(Yong Beom Cho),윤성현(Seong Hyeon Yun),김희철(Hee Cheol Kim),전호경(Ho-kyung Chun),이우용(Woo-Yong Lee) 대한종양외과학회 2012 Korean Journal of Clinical Oncology Vol.8 No.1

목적 : 본 연구는 예방적 장루와 치료적 장루 복원 수술의 합병증과 임상경과의 차이를 알아보고자 시행되었다. 대상과 방법 : 2006년 1월부터 2010년 12월까지 ○○병원 외과에서 결장직장암으로 근치적 수술과 회장루 조성술 후 장루 복원술을 시행 받은 19세 이상 373명을 대상으로 하였다. 이 중 예방적 회장루를 조성한 280명과 치료적 회장루를 조성한 93명의 장루복원 후 합병증과 임상경과를 비교 분석하였다. 결과 : 예방적 장루군과 치료적 장루군의 평균 나이는 각각 57.6세와 55.1세이었고 장루 조성 후 복원까지의 평균 기간은 각각 199.4일, 276.7일이었다. 예방적 장루군에서 27명(9.6%), 치료적 장루군에서 31명(35.4%)에서 합병증이 발생하였으며(p<0.01) 수술 후 평균 재원기간은 예방적 장루군이 6.9일, 치료적 장루군이 9.7일이었다(p<0.01). 장루 복원 후 합병증 발생에 영향을 끼치는 인자는 일변량 및 다변량 로지스틱 회귀분석에서 치료적 회장루 조성 후 장루 복원을 한 경우(p<0.01)로 나타났다. 결론 : 결장직장암수술에서 예방적 장루 복원술을 시행한 경우가 치료적 장루 복원술을 시행한 경우보다 회복기간 및 합병증 발생 측면에서 더 우월한 결과를 보였다. 따라서 문합이 불안하거나 낮을 경우 장루 조성 후 환자들의 불편함과 문합부 누출에 따른 재수술 및 장루 복원 후 합병증 증가를 고려하여 예방적 장루 조성의 실시 여부를 고려해야 할 것으로 생각된다. Backgrounds : The purpose of this study is to compare the complications after ileostomy take down between preventive and therapeutic ileostomy formation . Methods : From January 2006 through December 2010, 373 patients underwent closure of ileostomy. Inclusion criteria are as follows: 1) Patients undergoing an elective takedown of a temporary ileostomy in colorectal cancer; 2) age > 19. Excluded were patients with nonelective stoma take down and patients undertaken to treat anastomosis site stricture or anal stricture. 373 patients are included in the analysis: 280 Protective and 93 therapeutic. Results : The morbidity rate of protective ileostomy take down is 22.1% and therapeutic ileostomy take down is 30.3%. Ileus is the most common complication in both groups. Those who underwent therapeutic ileostomy have longer postoperative hospital stay (6.9 days vs 9.7 days)(p<0.01), and they also need more time to eat soft blended diet compared to preventive ileostomy group (3.9 days vs 6.8 days)(p<0.05).The variables affecting to complications after ileostomy take down in MultipleLogistic Regression Analysis analysis were therapeutic ileostomy take down(p<0.01). Conclusion : In the colorectal cancer surgery, preventive ileostomy take down showed better outcomes than therapeutic ileostomy after take down. Thus, in the case whenanastomosis is unstable or low, it is important to consider inconvenience of patients, risk of re-surgery due to anastomosis site leakage and increase in complications after therapeutic ileostomy take down when we performing of preventive ileostomy formation.

회장루의 합병증과 관련인자 분석

김정연,김진수,허혁,민병소,김남규,손승국,조장환 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.2

Purpose: The proportion of sphincter-saving operations for lower rectal cancer is increasing with improved surgical techniques and additional concurrent preoperative chemo-radiation therapy. A defunctioning ileostomy or colostomy is performed after a sphincter-saving operation in the belief that diverting the fecal stream will prevent anastomotic leakage. This study was undertaken to assess all morbidity and combined problems associated with a temporary loop ileostomy. Methods: A total of 167 patients who had undergone an ileostomy after a proctectomy between July 1997 and May 2007 were enrolled in this study. All patients were analyzed retrospectively, and the enrolled patients were registered in the Colorectal Cancer Database and were followed prospectively. Three patients did not receive an ileostomy take-down operation because of tumor recurrence. Results: Complications of ileostomy formation developed in 20 (11.9%) cases. There were no significant relevant factors influencing the complications of ileostomy formation. Complications related with ileostomy take-down developed in 33 (17.9%) cases. Longer operation time, perioperative transfusion, and postoperative radiotherapy were statistically significant factors related to the complications of ileostomy take-down (P=0.047, P=0.019, P=0.042). After ileostomy take-down, six patients were identified with complications, such as a rectovaginal fistula or an anastomotic stenosis, related with rectal cancer surgery. Conclusion: The useful ileostomy sometimes carries certain morbidity; therefore, an ileostomy should be performed selectively, and the decision should be made with care. Also, a careful evaluation of the distal part of an ileostomy is necessary before and after an ileostomy take-down. Purpose: The proportion of sphincter-saving operations for lower rectal cancer is increasing with improved surgical techniques and additional concurrent preoperative chemo-radiation therapy. A defunctioning ileostomy or colostomy is performed after a sphincter-saving operation in the belief that diverting the fecal stream will prevent anastomotic leakage. This study was undertaken to assess all morbidity and combined problems associated with a temporary loop ileostomy. Methods: A total of 167 patients who had undergone an ileostomy after a proctectomy between July 1997 and May 2007 were enrolled in this study. All patients were analyzed retrospectively, and the enrolled patients were registered in the Colorectal Cancer Database and were followed prospectively. Three patients did not receive an ileostomy take-down operation because of tumor recurrence. Results: Complications of ileostomy formation developed in 20 (11.9%) cases. There were no significant relevant factors influencing the complications of ileostomy formation. Complications related with ileostomy take-down developed in 33 (17.9%) cases. Longer operation time, perioperative transfusion, and postoperative radiotherapy were statistically significant factors related to the complications of ileostomy take-down (P=0.047, P=0.019, P=0.042). After ileostomy take-down, six patients were identified with complications, such as a rectovaginal fistula or an anastomotic stenosis, related with rectal cancer surgery. Conclusion: The useful ileostomy sometimes carries certain morbidity; therefore, an ileostomy should be performed selectively, and the decision should be made with care. Also, a careful evaluation of the distal part of an ileostomy is necessary before and after an ileostomy take-down.

전대장절제술 및 회장낭항문문합술에서 우회성 회장루의 필요성

홍동현,유창식,남궁환,조영규,김희철,김진천 대한대장항문학회 2002 Annals of Coloproctolgy Vol.18 No.6

회장조루술의 합병증

송기원,유창식,이혜옥,김미숙,남궁환,이강홍,김희철,김진천 대한대장항문학회 2003 Annals of Coloproctolgy Vol.19 No.2

일시적 회장루 보유자를 위한 건강관리 임파워먼트 프로그램 개발 및 효과검증

김진미(Kim, Jin Mi),박정숙(Park, Jeong Sook) 한국성인간호학회 2021 성인간호학회지 Vol.33 No.6

궤양성 대장염 환자에서 시행되는 회장낭 수술에 대한 이견

유창식 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.3

Restorative proctocolectomy (RPC) has become a standard procedure over 30 yr in patients with ulcerative colitis and familial adenomatous polyposis. However, there are several controversies in surgical method and strategy. From oncological point of view, mucosal proctectomy and hand-sewn ileal pouch anal anastomosis has advantage because of relatively complete removal of columnar epithelium. However, long-term follow-up results after stapled anastomosis revealed extremely low incidence of dysplasia in the anal transitional zone (ATZ). Furthermore, recent publication of 26 cancer occurrence after RPC showed more prevalence in mucosectomy group. Risk factors of dysplasia after RPC are supervening cancer or dysplasia on the proximal colon, long duration of symptom, and history of primary sclerosing cholangitis. Preservation of ATZ by stapled anastomosis may have functional superiority, which is supported by some manometric and functional studies. However, two randomized controlled trials showed no difference between the groups. Although there are some surgeons who advocate one stage RPC, majority of centers prefer two stage RPC with ileostomy. According to meta-analysis one stage RPC revealed 2-3 times frequent anastomotic leakage or pelvic sepsis. Five to ten percent of ulcerative colitis has some pathologic characteristics of Crohn’s disease, which is classified as indeterminate colitis (IC). Long-term results of RPC in patients with IC revealed similar results with ulcerative colitis and superior to Crohn’s disease. So RPC may be justified in patients with IC. Conclusively, RPC should be tailored according to clinicopathologic details and operative findings. Restorative proctocolectomy (RPC) has become a standard procedure over 30 yr in patients with ulcerative colitis and familial adenomatous polyposis. However, there are several controversies in surgical method and strategy. From oncological point of view, mucosal proctectomy and hand-sewn ileal pouch anal anastomosis has advantage because of relatively complete removal of columnar epithelium. However, long-term follow-up results after stapled anastomosis revealed extremely low incidence of dysplasia in the anal transitional zone (ATZ). Furthermore, recent publication of 26 cancer occurrence after RPC showed more prevalence in mucosectomy group. Risk factors of dysplasia after RPC are supervening cancer or dysplasia on the proximal colon, long duration of symptom, and history of primary sclerosing cholangitis. Preservation of ATZ by stapled anastomosis may have functional superiority, which is supported by some manometric and functional studies. However, two randomized controlled trials showed no difference between the groups. Although there are some surgeons who advocate one stage RPC, majority of centers prefer two stage RPC with ileostomy. According to meta-analysis one stage RPC revealed 2-3 times frequent anastomotic leakage or pelvic sepsis. Five to ten percent of ulcerative colitis has some pathologic characteristics of Crohn’s disease, which is classified as indeterminate colitis (IC). Long-term results of RPC in patients with IC revealed similar results with ulcerative colitis and superior to Crohn’s disease. So RPC may be justified in patients with IC. Conclusively, RPC should be tailored according to clinicopathologic details and operative findings.