Prolongirani postoperativni ileus posle elektivne kolorektalne hirurgije zbog karcinoma
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 (χ2 = 34.966; p < 0.001), komplikacija III stepena (χ2 = 23.43; p < 0.001) i reoperacija (χ2 = 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.
Reference
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