【评论】Turnbull-Cutait分期拖出式结肠肛管吻合术治疗低位直肠癌的长期疗效:一项随机临床试验  

[Comment]Long-term results of 2-stage turnbull-cutait pull-through coloanal anastomosis for low rectal cancer:a randomized clinical trial

作　　者：王一民 孙凌宇[1] Wang Yimin;Sun Lingyu

机构地区：[1]哈尔滨医科大学附属第四医院肿瘤外科,黑龙江哈尔滨150000

出　　处：《结直肠肛门外科》2024年第5期631-633,共3页Journal of Colorectal & Anal Surgery

摘　　要：价值在接受低位直肠癌手术的患者中,Turnbull-Cutait分期拖出式手工结肠肛管吻合术与标准结肠肛管吻合+转流性回肠造口+后续回肠造口还纳术相比,在术后并发症方面有更大的优势。目的比较两种技术在超低位直肠切除术治疗直肠癌的长期效果。设计,设置和参与者在这个随机多中心临床试验中,患者和外科医师均设盲。患者在3个中心招募。需要手工结肠肛管吻合术的患者被随机分配到Turnbull-Cutait分期拖出式手工结肠肛管吻合术组(n=46)或标准手工结肠肛管吻合术组(n=46)。干预所有患者接受了超低位直肠前切除手术。分配到Turnbull-Cutait分期拖出式手工结肠肛管吻合术组的患者经过肛管拖出部分左侧结肠,6~10 d后切除外露的结肠,并进行延期的结肠肛管吻合术。标准手工结肠肛管吻合术组的患者,在首次手术中采用结肠肛管吻合术+转流性回肠造口,术后约6~8个月辅助治疗完成后进行回肠造口还纳。研究终点主要终点是术后3年手术相关并发症发生率,次要终点是功能结果(低位前切除综合征评分、Wexner肛门失禁评分和结直肠功能结果问卷评分)和肿瘤学结果(总生存期、无病生存期、远处转移、局部复发)。数据分析时间为2018年10月1日至2021年10月31日。结果3年随访时间内,Turnbull-Cutait分期拖出式手工结肠肛管吻合术组与标准手工结肠肛管吻合术组分别有9例患者(19.6%)和6例患者(13.0%)出现并发症,但统计学上没有显著差异(P=0.57)。两组间肿瘤学结果相似。标准手工结肠肛管吻合术组和Turnbull-Cutait分期拖出式手工结肠肛管吻合术组Wexner肛门失禁评分分别为10.9(5.5,15.5)分与13.0(7.3,16.0)分,低位前切除综合征评分分别为32.0(21.0,37.0)分与34.0(23.2,38.5)分,结直肠功能结果问卷评分分别为38.5(23.0,47.1)分与40.8(23.3,58.2)分,3项评分比较差异无统计学意义。结论对于超低位直肠癌Importance In patients operated on for low rectal cancer,2-stage Turnbull-Cutait pull-through hand-sewn coloanal anastomosis provides benefits in terms of postoperative morbidity compared with standard hand-sewn coloanal anastomosis associated with diverting ileostomy and further ileostomy reversal.Objective To compare long-term results of these 2 techniques after ultralow rectal resection for rectal cancer.Design,setting,and participants In this randomized multicenter clinical trial,neither patients nor surgeons were blinded for technique.Patients were recruited in 3 centers.Patients undergoing ultralow anterior rectal resection needing hand-sewn coloanal anastomosis were randomly assigned to 2-stage Turnbull-Cutait pull-through hand-sewn coloanal anastomosis(n=46)or standard hand-sewn coloanal anastomosis associated with diverting ileostomy(n=46).Interventions All patients underwent ultralow anterior resection.Patients assigned to the 2-stage Turnbull-Cutait pull-through group underwent exteriorization of a segment of left colon through the anal canal.After 6 to 10 days,the exteriorized colon was resected and a delayed hand-sewn coloanal anastomosis performed.For patients assigned to standard coloanal anastomosis,the hand-sewn coloanal anastomosis was performed with diverting ileostomy during the first operation.Ileostomy closure was scheduled after adjuvant treatment was completed in about 6 to 8 months.Main outcome and measure The study aimed to compare the differences between the 2 groups in terms of long-term surgery-related morbidity,functional,and oncological outcomes at 3 years postoperatively.Data were analyzed from October 1,2018,through October 31,2021.Results The 92 patients randomized in the first study were included for the 3-year follow-up.The overall morbidity rate in the 2 groups showed that 15 patients(16.3%)had complications with a difference of 6.52(95%CI,-8.93 to 21.79).Nine patients(19.6%)and 6 patients(13.0%)in the 2-stage Turnbull-Cutait pull-through group and hand-sewn coloanal anastomos

关 键 词：低位直肠癌 Turnbull-Cutait分期拖出式手工结肠肛管吻合术 并发症 结直肠功能评分 生活质量 回肠造口 

分 类 号：R735.3[医药卫生—肿瘤]