直肠癌前切除术后预防性回肠造口无法回纳因素分析  

作　　者：王林月 林胜红 方振军[1] 陈贵平 

机构地区：[1]浙江省安吉县中医院,313399 [2]浙江中医药大学附属第一医院,310003

出　　处：《浙江临床医学》2024年第3期422-424,共3页Zhejiang Clinical Medical Journal

摘　　要：目的 探讨直肠癌前切除术预防性回肠造口无法回纳的相关因素。方法 收集2010年1月至2021年12月直肠癌前切除后并行预防性回肠造口187例患者的临床资料,分析临床病理资料及随访信息。结果 187例患者中有32例未完成回肠造口回纳,未回纳率17.1%。单因素分析显示,有新辅助放化疗病史、低位直肠肿瘤、肿瘤分期较晚、术后有吻合口并发症、肠梗阻及肿瘤进展包括局部复发和远处转移与无法还纳相关。多因素分析显示,吻合口相关并发症、局部复发或远处转移是直肠癌根治术后预防性回肠造口无法还纳的独立预后因素(P<0.05)。结论 对于有回肠造口无法回纳的高危因素如术后吻合口并发症、术前肿瘤晚期或有术后复发或转移高危因素的患者,要充分考虑到术后回肠造口无法回纳的可能性,谨慎选择手术及造口方式。Objective To analyze the factors associated with the inability to revert preventive ileostomy after anterior resection of rectal cancer.Methods Clinical data were collected from 187 patients with concurrent prophylactic ileostomy after rectal precancerous resection from January 2010 to December 2021,and clinicopathological data and follow-up information were analyzed.Results In this study,187 patients were included in the analysis,among which 32 patients did not complete ileostomy return,and the unreturn rate was 17.1%.Univariate analysis showed that the factors related to unreturn included history of neoadjuvant radiotherapy and chemotherapy,low rectal tumor,late tumor stage,postoperative anastomotic complications,intestinal obstruction and tumor progression including local recurrence and distant metastasis.Multivariate analysis showed that anastomotic complications,local recurrence or distant metastasis were independent prognostic factors of unreturn of preventive ileostomy after radical resection of rectal cancer(P<0.05).Conclusion For patients with high risk factors of ileostomy,such as postoperative anastomotic complications,advanced tumor before operation or high risk factors of postoperative recurrence or metastasis,the possibility of ileostomy after operation should be fully considered,and the operation and ostomy methods should be carefully selected.

关 键 词：直肠肿瘤 前切除术 预防性回肠造口 

分 类 号：R735.37[医药卫生—肿瘤]