腹腔镜直肠癌前切除手术临时性造口术后不能闭合的危险因素分析  

Risk factors for failure to close a temporary stoma in rectal cancer patients following transabdominal laparoscopic anterior resection

作　　者：陶俊[1] 束宽山[1] 郑明[1] 王贵和[1] TAO Jun;SHU Kuanshan;ZHENG Ming;WANG Guihe(Department of Gastrointestinal Surgery,Tongling People′s Hospital,Tongling 244000,China)

机构地区：[1]铜陵市人民医院胃肠外科,安徽铜陵244000

出　　处：《皖南医学院学报》2022年第5期440-443,共4页Journal of Wannan Medical College

基　　金：铜陵市科技计划项目(2017NS21);铜陵市卫生健康委医学科研项目[卫科研(2019)15号]。

摘　　要：目的:探讨腹腔镜直肠癌前切除手术临时性造口转为永久性造口的危险因素,以期在术前指导临床治疗及术后加强对高危人群的随访。方法:收集2012年1月~2019年12月在铜陵市人民医院胃肠外科行腹腔镜辅助经腹直肠癌前切除并行临时性造口手术患者的临床资料。共168例患者纳入本研究,其中预防性造口144例,挽救性造口24例。单因素分析造口不能闭合的临床特征,将有意义的变量纳入Logistic回归分析模型,进行多因素分析。结果:168例临时性造口患者中134例(79.8%)成功还纳闭合,34例转为永久性造口。单因素分析显示新辅助放化疗、吻合口漏、吻合口狭窄、术后局部复发、术后远处转移为造口不能闭合的原因,多因素分析显示吻合口漏为造口不能闭合的独立危险因素。结论:临时性造口存在造口永久化风险,术者需审慎考虑临时性造口的转归和影响因素。Objective:To explore the risk factors of temporary stoma to permanent stoma in rectal cancer patients after transabdominal laparoscopic anterior resection for guidance to clinical treatment before operation and strengthening postoperative follow-up in patients with high-risk.Methods:The clinical data were obtained from patients undergone transabdominal anterior resection of the rectal cancer assisted by laparoscopy and temporary colostomy in our department between January 2012 and December 2019.Of the 168 patients included, 144 underwent prophylactic stoma, and 24 salvage colostomy.Univariate analysis was performed to analyze the clinical characteristics of failure of stoma closure, and then the significant variables were incorporate into Logistic regression model for multivariate analysis.Results:Temporary colostomy was successfully closed in 134 of the 168 patients(79.8%),and 34 patients were converted to permanent stoma.Univariate analysis showed that neo-adjuvant chemoradiotherapy, anastomotic leakage and stenosis, postoperative local recurrence and distant metastasis were the causes for failure of stoma closure.Multivariate analysis indicated that anastomotic leakage was an independent risk factor for the failure of colostomy closure.Conclusion:There is a risk of for temporary stoma to be converted into a permanent stoma.The results suggest that surgeons should take careful account of the outcomes and factors affecting temporary stoma.

关 键 词：直肠肿瘤 末端回肠造口 永久性造口 经腹直肠前切除术 腹腔镜 

分 类 号：R735.37[医药卫生—肿瘤]