| 赵传多,周思成,苏 昊.279例直肠癌低位前切除术中临时性造口的应用分析[J].肿瘤学杂志,2021,27(6):474-479. |
| 279例直肠癌低位前切除术中临时性造口的应用分析 |
| Short-term Outcomes of Temporary Ostomy in Low Anterior Resection for Rectal Cancer：An Analysis of 279 Cases |
| 投稿时间：2021-03-16 |
| DOI：10.11735/j.issn.1671-170X.2021.06.B011 |
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| 中文关键词: 临时性造口 低位前切除术 吻合口瘘 直肠肿瘤 |
| 英文关键词:temporary ostomy low anterior resection anastomotic leakage rectal neoplasms |
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| 中文摘要: |
| 摘 要：［目的］ 分析直肠癌低位前切除术（low anterior resection，LAR）中临时性造口的效果，为评估临时性造口的必要性和可行性提供临床决策依据。［方法］ 在中国医学科学院北京协和医学院肿瘤医院收治的2 321例行直肠癌LAR患者中，根据是否行临时性造口进行1∶1倾向性评分匹配，共匹配279对。收集患者围手术期相关指标及术后1年的随访数据来评估造口相关指标情况。定量变量使用t检验，分类变量使用卡方检验或Fisher检验进行统计学分析。［结果］ 造口组术前放化疗比例高于未造口组（39.4% vs 10.0%，P<0.001），肿瘤位置低于未造口组（距肛缘6.0cm vs 9.0cm，P< 0.001）。与未造口组相比，造口组吻合口瘘发生率更低（0.4% vs 3.6%，P=0.039），二次手术率更低（0.4% vs 2.9%，P=0.044），手术时间更长（214.8min vs 151.3min，P=0.009），首次排气时间更短（3.4d vs 4.1d，P=0.005）。还纳手术是相对安全的，但21.1%的造口患者在第一次手术后1年内因各种原因未完成还纳手术。年龄大（P=0.029）和AJCC分期晚（P=0.043）可能是影响造口不能还纳的高危因素。［结论］ 对于高危患者，临时性造口手术耗时长，但可以降低LAR吻合口瘘发生率和再手术率。考虑到日常生活不便、其他相关并发症，以及较高的不能还纳比例等问题，临时性造口应更多地应用于低位吻合及新辅助治疗后的患者。 |
| 英文摘要: |
| Abstract：［Objective］ To analyze the effectiveness of temporary ostomy in low anterior resection(LAR) for rectal cancer.［Methods］ Propensity score matching was performed among 2 321 rectal cancer patients with LAR in Cancer Hospital，Chinese Academy of Medical Science and Peking Union Medical College. According to whether or not temporary ostomy was performed，a total of 279 pairs were matched to compare the differences in terms of short-term outcomes. Follow-up data were collected during the perioperative period and 1 year follow-up after the operation to evaluate the clinical outcomes of ostomy. Quantitative variables were analyzed using t-test，and categorical variables were analyzed using chi-square test and Fisher test.［Results］ The ostomy group had a higher proportion of chemoradiotherapy(39.4% vs 10.0%，P<0.001) and a lower site of anastomosis(6.0cm vs 9.0cm，P<0.001) than the non-ostomy group. The ostomy group had a lower rate of anastomotic leakage(0.4% vs 3.6%，P=0.039) and reduced reoperation rate(0.4% vs 2.9%，P=0.044)，longer operating time(214.8min vs 151.3min，P=0.009) and shorter interval to first flatus(3.4 days vs 4.1 days，P=0.005) than the non-ostomy group. The safety of reversal surgery was acceptable；however，21.1% of ostomates did not complete the reversal operation for various reasons within 1 year after the first operation. Age(P=0.029) and AJCC stage(P=0.043) were factors affecting the closure of ostomy. ［Conclusion］ Although LAR is time consuming，temporary ostomy is still a good option for high-risk patients to reduce the possibility of anastomotic leakage and reoperation. Considering the ostomy-related inconveniences in daily living，other related complications and rather high proportion of non-reversal，temporary ostomy should be applied more often for patients with low anastomosis and neoadjuvant treatment. |
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