中国普外基础与临床杂志

中国普外基础与临床杂志

直肠癌保括约肌手术患者预防性回肠造口延迟回纳的危险因素

查看全文

目的探讨直肠癌术后预防性回肠造口延迟回纳的相关危险因素。方法回顾性分析 2014 年1 月至 2014 年 12 月期间中山大学附属第六医院行预防性回肠造口关闭的 130 例直肠癌患者的临床资料,根据造口回纳时间分为延迟回纳组 72 例(≥120 d)和正常回纳组 58 例(<120 d)。结果130 例患者的肠造口回纳时间为 39~692 d,中位数为 132 d。多因素分析结果提示,术后辅助化疗(OR=12.302,P=0.002)、肿瘤距肛缘的距离(OR=14.236,P=0.006)及术后吻合口漏(OR=15.631,P=0.005)是延迟回纳的独立危险因素,术后辅助化疗及发生吻合口漏患者的回纳时间延长,随肿瘤距肛缘的距离延长,回纳时间延长。结论直肠癌术后辅助化疗、肿瘤距肛缘的距离长和术后发生吻合口漏会延迟预防性回肠造口的关闭时间。

ObjectiveThis study aimed to discuss the risk factors associated with the delay reversal ileostomy following sphincter-preserving surgery for rectal cancer.MethodsClinical data were collected retrospectively on 130 consecutive patients undergoing defunctioning ileostomy following sphincter-preserving surgery for rectal cancer, between January 2014 and December 2014 in the Sixth Affiliated Hospital of Sun Yat-sen University. According to the reversal time of ileostomy, the patients were divided into two groups, including the delay reversal ileostomy group (≥120 d, n=72) and the normal ileostomy group (<120 d, n=58).ResultsOne hundred and thirty patients were studied (median time to reversal 132 d, range 39–692 d). Logistic regression model showed that adjuvant chemotherapy (OR=12.302, P=0.002), distance of tumor from the anal verge (OR=14.236, P=0.006), and anastomotic leakage (OR=15.631, P=0.005) were significant independent risk factors for delayed reversal. Time to reversal was significantly longer in those patients who had adjuvant chemotherapy, anastomotic leakage, and long distance of tumor from the anal verge.ConclusionAdjuvant chemotherapy, long distance of tumor from the anal verge, and anastomotic leakage were the independent risk factors for delay reversal ileostomy following sphincter-preserving surgery for rectal cancer.

关键词: 直肠癌; 延迟回纳; 保括约肌手术; 预防性回肠造口

Key words: rectal cancer; delay reversal; sphincter-preserving surgery; defunctioning ileostomy

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Hüser N, Michalski CW, Erkan M, et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg, 2008, 248(1): 52-60.
2. Gastinger I. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg, 2005, 92(9): 1137-1142.
3. Chen J, Wang DR, Yu HF, et al. Defunctioning stoma in low anterior resection for rectal cancer: a meta- analysis of five recent studies. Hepatogastroenterology, 2012, 59(118): 1828-1831.
4. Tan WS, Tang CL, Shi L, et al. Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg, 2009, 96(5): 462-472.
5. Snijders HS, van den Broek CB, Wouters MW, et al. An increasing use of defunctioning stomas after low anterior resection for rectal cancer. Is this the way to go? Eur J Surg Oncol, 2013, 39(7): 715-720.
6. Åkesson O, Syk I, Lindmark G, et al. Morbidity related to defunctioning loop ileostomy in low anterior resection. Int J Colorectal Dis, 2012, 27(12): 1619-1623.
7. Ihnát P, Guňková P, Peteja M, et al. Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection. Surg Endosc, 2016, 30(11): 4809-4816.
8. Tsunoda A, Tsunoda Y, Narita K, et al. Quality of life after low anterior resection and temporary loop ileostomy. Dis Colon Rectum, 2008, 51(2): 218-222.
9. 苏端玉, 吴君心, 侯如蓉. 长期生存直肠癌患者生存质量的临床影响因素分析. 中国肿瘤临床, 2014, 41(3): 175-179.
10. Rubio-Perez I, Leon M, Pastor D, et al. Increased postoperative complications after protective ileostomy closure delay: an institutional study. World J Gastrointest Surg, 2014, 6(9): 169-174.
11. Chow A, Tilney HS, Paraskeva P, et al. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis, 2009, 24(6): 711-723.
12. Akiyoshi T, Fujimoto Y, Konishi T, et al. Complications of loop ileostomy closure in patients with rectal tumor. World J Surg, 2010, 34(8): 1937-1942.
13. Mengual-Ballester M, García-Marín JA, Pellicer-Franco E, et al. Protective ileostomy: complications and mortality associated with its closure. Rev Esp Enferm Dig, 2012, 104(7): 350-354.
14. Chun LJ, Haigh PI, Tam MS, et al. Defunctioning loop ileostomy for pelvic anastomoses: predictors of morbidity and nonclosure. Dis Colon Rectum, 2012, 55(2): 167-174.
15. Messaris E, Sehgal R, Deiling S, et al. Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum, 2012, 55(2): 175-180.
16. den Dulk M, Smit M, Peeters KC, et al. A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study. Lancet Oncol, 2007, 8(4): 297-303.
17. Waterland P, Goonetilleke K, Naumann DN, et al. Defunctioning ileostomy reversal rates and reasons for delayed reversal: does delay impact on complications of ileostomy reversal? A study of 170 defunctioning ileostomies. J Clin Med Res, 2015, 7(9): 685-689.
18. Pan HD, Peng YF, Wang L, et al. Risk factors for nonclosure of a temporary defunctioning ileostomy following anterior resection of rectal cancer. Dis Colon Rectum, 2016, 59(2): 94-100.
19. Gustafsson CP, Gunnarsson U, Dahlstrand U, et al. Loop-ileostomy reversal-patient-related characteristics influencing time to closure. Int J Colorectal Dis, 2018, 33(5): 593-600.
20. Luglio G, Pendlimari R, Holubar SD, et al. Loop ileostomy reversal after colon and rectal surgery: a single institutional 5-year experience in 944 patients. Arch Surg, 2011, 146(10): 1191-1196.
21. Chand M, Nash GF, Talbot RW. Timely closure of loop ileostomy following anterior resection for rectal cancer. Eur J Cancer Care (Engl), 2008, 17(6): 611-615.
22. Lordan JT, Heywood R, Shirol S, et al. Following anterior resection for rectal cancer, defunctioning ileostomy closure may be significantly delayed by adjuvant chemotherapy: a retrospective study. Colorectal Dis, 2007, 9(5): 420-422.
23. 丛进春, 陈春生, 冯勇, 等. 新辅助治疗对低位直肠癌经内外括约肌间切除术后肛门功能的影响. 中国肿瘤临床, 2013, 40(23): 1450-1454.
24. Snijders HS, Wouters MW, van Leersum NJ, et al. Meta-analysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality. Eur J Surg Oncol, 2012, 38(11): 1013-1019.
25. van Koperen PJ, van der Zaag ES, Omloo JM, et al. The persisting presacral sinus after anastomotic leakage following anterior resection or restorative proctocolectomy. Colorectal Dis, 2011, 13(1): 26-29.
26. Kim MJ, Kim YS, Park SC, et al. Risk factors for permanent stoma after rectal cancer surgery with temporary ileostomy. Surgery, 2016, 159(3): 721-727.
27. Sier MF, van Gelder L, Ubbink DT, et al. Factors affecting timing of closure and non-reversal of temporary ileostomies. Int J Colorectal Dis, 2015, 30(9): 1185-1192.