Rektum kanseri cerrahisinde ileostomi kapatılma yönteminin fonksiyonel etkisinin araştırılması
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Tarih
2024
Yazarlar
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Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Rektum kanseri sebebiyle opere edilen hastalarda koruyucu ileostomi gereksinimi olabilmektedir. İleostomi kapatılmasında çeşitli yöntemler kullanılmaktadır ancak kesinleşmiş bir yöntem yoktur. Bu çalışmada amacımız ileostomi kapatılma yöntemlerinin defekasyon fonksiyonuna etkisini araştırmaktır.
Materyal ve Metod: Necmettin Erbakan Üniversitesi Tıp Fakültesi Genel Cerrahi Kliniği’nde Ocak 2019 – Ocak 2024 tarihleri arasında rektum kanseri sebebi ile opere edilip koruyucu ileostomi açılan, sonrasında ileostomisi hastanemizde kapatılan hastalar belirlendi.
Belirlenen hastalar içerisinden ileostomi kapatılmasından sonraki 4 ay içerisinde abdominal bilgisayarlı tomografi (BT) çekilen hastalar seçildi. İleostomi kapatılma yöntemine göre çalışma kriterlerini karşılayan gruplardan randomize 40’ar adet hasta belirlendi.
Çalışmamızda hastaların yaşı, cinsiyeti, operasyon sonrası batın dreni konulup konulmadığı, operasyon süresi, operasyondan sonraki hastaneden taburculuk süresi, stapler ile kapatılan hastalarda kullanılan stapler sayısı ve boyutu, ileum çapları, barsak tıkanıklığı semptomları gelişip gelişmediği ve LARS skorları incelendi.
Bulgular: Çalışmamızda stapler yardımıyla ileostomisi kapatılan hastaların sütür yardımıyla ileostomisi kapatılan hastalara göre ileum çaplarının geniş olduğu, daha az barsak tıkanıklığı semptomları yaşadıkları, operasyon ve taburculuk süresinin daha kısa olduğu, daha az intraabdominal dren kullanıldığı ve LARS skorlarının daha düşük olduğu görüldü.
Sonuç: Stapler ile ileostomisi kapatılan hastaların sütür ile ileostomisi kapatılan hastalara göre daha az barsak tıkanıklığı semptomları gösterdiği, hastaneden taburculuk ve operasyon sürelerini önemli ölçüde kısaldığı görülmüştür. Yapılan literatür çalışmalarında ileostomi kapatılma tekniği ile ilgili birliktelik sağlanamamıştır. Bundan dolayı çokmerkezli, prospektif ve daha geniş kapsamlı çalışmalar yapılarak literatüre kazandırılmalıdır. Bu sayede rektum kanserli olgularda açılan koruyucu ileostominin kapatılma yönteminin belirlenmesine ışık tutabilir.
Objective: In patients operated for rectal cancer, there may be a need for a diverting ileostomy. Various methods are used in ileostomy closure, yet a definitive method has not been established. The aim of this study is to investigate the impact of ileostomy closure techniques on defecation function. Materials and Methods: Patients who were operated for rectal cancer and had a diverting ileostomy opened at Necmettin Erbakan University Faculty of Medicine, Department of General Surgery, between January 2019 and January 2024, and whose ileostomy was closed at our hospital, were identified. Among these patients, those who underwent abdominal computed tomography (CT) within four months after ileostomy closure were selected. Based on the ileostomy closure technique, groups meeting the study criteria were randomized, and 40 patients were determined from each group. In our study, patients' age, gender, whether an abdominal drain was placed post-operatively, operation duration, discharge time from the hospital after the operation, the number and size of staplers used in patients whose ileostomy was closed with staplers, ileum diameters, development of bowel obstruction symptoms, and LARS scores were examined. Findings: In our study, it was observed that patients whose ileostomy was closed with the help of staplers had wider ileum diameters, experienced fewer bowel obstruction symptoms, had shorter operation and hospital discharge times, used fewer intraabdominal drains, and had lower LARS scores compared to patients whose ileostomy was closed with sutures. Conclusion: Patients whose ileostomy was closed with staplers showed fewer bowel obstruction symptoms, and significant reductions in hospital discharge and operation times, compared to those whose ileostomy was closed with sutures. Literature studies have not reached a consensus on the ileostomy closure technique. Therefore, multi-center,prospective, and more comprehensive studies should be conducted to contribute to the literature. This can shed light on determining the method of closing diverting ileostomy in cases of rectal cancer.
Objective: In patients operated for rectal cancer, there may be a need for a diverting ileostomy. Various methods are used in ileostomy closure, yet a definitive method has not been established. The aim of this study is to investigate the impact of ileostomy closure techniques on defecation function. Materials and Methods: Patients who were operated for rectal cancer and had a diverting ileostomy opened at Necmettin Erbakan University Faculty of Medicine, Department of General Surgery, between January 2019 and January 2024, and whose ileostomy was closed at our hospital, were identified. Among these patients, those who underwent abdominal computed tomography (CT) within four months after ileostomy closure were selected. Based on the ileostomy closure technique, groups meeting the study criteria were randomized, and 40 patients were determined from each group. In our study, patients' age, gender, whether an abdominal drain was placed post-operatively, operation duration, discharge time from the hospital after the operation, the number and size of staplers used in patients whose ileostomy was closed with staplers, ileum diameters, development of bowel obstruction symptoms, and LARS scores were examined. Findings: In our study, it was observed that patients whose ileostomy was closed with the help of staplers had wider ileum diameters, experienced fewer bowel obstruction symptoms, had shorter operation and hospital discharge times, used fewer intraabdominal drains, and had lower LARS scores compared to patients whose ileostomy was closed with sutures. Conclusion: Patients whose ileostomy was closed with staplers showed fewer bowel obstruction symptoms, and significant reductions in hospital discharge and operation times, compared to those whose ileostomy was closed with sutures. Literature studies have not reached a consensus on the ileostomy closure technique. Therefore, multi-center,prospective, and more comprehensive studies should be conducted to contribute to the literature. This can shed light on determining the method of closing diverting ileostomy in cases of rectal cancer.
Açıklama
Anahtar Kelimeler
ileostomi kapatılması, ileostomy closure, Rektal kanser, Rectal cancer, LARS
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Karadoğan, M. F. (2024). Rektum kanseri cerrahisinde ileostomi kapatılma yönteminin fonksiyonel etkisinin araştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Genel Cerrahi Anabilim Dalı, Konya.
