经腹直肠癌前切除术临时性造口永久化的危险因素分析  

Risk factors of permanent stoma in rectal cancer patients undergoing transabdominal anterior resection with temporary stoma

作　　者：汪欣宇 陶燃 屈展[1,2] 张宇 邓友铭[1,2] 易嘉宁 邓牧野 刘蔚东 Wang Xinyu;Tao Ran;Qu Zhan;Zhang Yu;Deng Youming;Yi Jianing;Deng Muye;Liu Weidong(Department of General Surgery,Xiangya Hospital,Central South University,Changsha,Hunan 410008,China;National Clinical Research Center for Geriatric Disorders(Xiangya),Changsha,Hunan 410008,China;Department of General Surgery,the First Affiliated Hospital of Hunan Normal University Hunan Provincial People's Hospital,Changsha,Hunan 410005,China;School of Mathematics and Statistics,Central South University,Changsha,Hunan 410012,China)

机构地区：[1]中南大学湘雅医院普通外科,长沙410008 [2]国家老年疾病临床医学研究中心(湘雅),长沙410008 [3]湖南师范大学附属第一医院湖南省人民医院普通外科,长沙410005 [4]中南大学数学与统计学院,长沙410012

出　　处：《中华胃肠外科杂志》2020年第8期780-785,共6页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的临时性造口可降低吻合口漏的发生率,改善直肠癌患者的预后。然而,如果造口超过1年未能还纳,易转变为永久性造口,影响患者生活质量和心理健康。为提高造口还纳率,本研究探讨经腹直肠癌前切除术临时性造口成为永久性造口的相关危险因素。方法采用病例对照研究方法,分析2008年6月至2018年6月期间,在中南大学湘雅医院普通外科接受经腹直肠癌前切除术并临时性造口、术后完成随访的直肠癌病例资料。本研究中,临时性造口包括预防性造口(即经腹直肠癌前切除术的同时行造口手术)和挽救性造口(即经腹直肠癌前切除术时未造口,但术后1个月内因出现吻合口漏或其他严重并发症需再次行造口手术)。共308例直肠癌患者被纳入研究,其中男性198例,女性110例,中位年龄56(48~65)岁。94例接受术中腹腔化疗,高位、中位和低位直肠肿瘤患者分别为64例、89例和155例。20例接受横结肠造口,288例接受回肠末端造口。2019年8—9月集中进行电话随访,详细了解患者造口还纳和未能还纳原因、肿瘤是否复发等情况。造口永久化定义为患者在最后一次随访时造口仍无还纳。使用χ2检验或Fisher确切概率法对临时性造口永久化相关的临床特征进行单因素分析,并将其中P<0.10的因素纳入非条件logistic逐步回归分析模型,进行多因素分析。结果中位随访54.3(32.4~73.8)个月,局部复发8例,远处转移37例。308例临时性造口患者中有247例(80.2%)还纳,还纳时间距造口手术时间中位数为4.5(3.5~6.1)个月。预防性造口患者还纳182例,还纳时间为4.2(3.4~5.5)个月;挽救性造口患者还纳65例,还纳时间为5.5(4.3~7.5)个月,两组还纳时间差异有统计学意义(Z=-4.387,P<0.001)。61例(19.8%)转变为永久性造口,其中预防性造口者45例,挽救性造口者16例。单因素分析显示,导致临时性造口永久化的危险因素包括术前贫血、�Objective To investigate the risk factors of turning temporary stoma into permanent stoma in rectal cancer patients undergoing transabdominal anterior resection with temporary stoma.Methods A case-control study was carried out.Data of rectal cancer patients who underwent transabdominal anterior resection with temporary stoma and completed follow-up in Department of General Surgery of Xiangya Hospital of Central South University from June 2008 to June 2018 were collected and analyzed.In this study,temporary stoma included defunctioning stoma(ostomy was made during operation)and salvage stoma(ostomy was made within one month after operation due to anastomotic leakage or severe complications).Cases of multiple intestinal tumors were excluded.A total of 308 rectal cancer patients were enrolled in the study,including 198 males and 110 females with a median age of 56(48-65)years.Ninety-four patients received intraperitoneal chemotherapy during operation.Among 308 patients,upper rectal cancer was observed in 64 cases,middle rectal cancer in 89 cases and low rectal cancer in 155 cases.Twenty patients underwent transverse colostomy and 288 underwent ileostomy.Phone call following-up was conducted from August to September 2019 to investigate whether stoma was reversed,causes of reversal failure,and tumor relapsed or not in detail.Permanent stoma was defined as that the stoma was still not reversed by the latest follow-up.The univariate analysis was performed with chi-square test or Fisher's exact test,and variables with P value<0.10 were included in the non-conditional logistic regression model for multivariate analysis.Results The median follow-up time was 54.3(32.4-73.8)months.During follow-up,8 cases had local recurrence and 37 cases had distant metastasis.Among the 308 patients with temporary ostomy,247(80.2%)patients had stomas reversed and the median interval time was 4.5(3.5-6.1)months.The median interval time in 65 patients with salvage stoma was significantly longer that in 182 patients with defunctioning stoma[5.

关 键 词：直肠肿瘤 预防性造口 挽救性造口 永久性造口 经腹直肠癌切除术 

分 类 号：R735.37[医药卫生—肿瘤]