机构地区:[1]北京大学肿瘤医院(北京市肿瘤防治研究所)胃肠肿瘤中心三病区/恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]北京大学肿瘤医院(北京市肿瘤防治研究所)消化系肿瘤整合防治全国重点实验室/恶性肿瘤转化研究北京市重点实验室,北京100142
出 处:《中国普通外科杂志》2024年第10期1613-1622,共10页China Journal of General Surgery
摘 要:背景与目的:预防性临时造口作为一种简单有效减轻直肠癌术后吻合口漏的严重程度的方法,已经被广泛应用于直肠癌手术中,但部分预防性临时造口患者因各种因素不能还纳,从而转变为永久性造口。目前,造口永久化仍然是临床常见的一种不良后果,其发生原因仍不十分清楚。本研究通过分析单中心的连续性手术样本,探讨形成永久性造口的危险因素。方法:回顾性收集2020年1月—2023年3月在北京大学肿瘤医院胃肠肿瘤中心三病区行保留肛门的直肠癌手术联合预防性临时造口且完成超过12个月随访患者的临床资料。分析永久性造口的发生情况,比较永久性造口患者与造口还纳患者临床指标的差异,分析永久性造口的危险因素。永久造口定义为造口超过12个月未能还纳。结果:共纳入299例患者,其中268例(89.63%)如期还纳(造口关闭组),31例(10.37%)未还纳(永久造口组)。与造口关闭组比较,永久造口组初诊时远处器官转移发生率更高(7.5%vs.25.8%,P=0.003),同时,T3与T4期、N2期以及临床分期Ⅳ期比例更高(均P<0.05);术后总并发症(19.0%vs.41.9%,P=0.003)与严重并发症发生率(1.1%vs.9.7%,P=0.016)升高,吻合口漏发生率也升高(4.9%vs.19.4%,P=0.006)。Logistic回归分析结果显示,初诊时合并远处器官转移(OR=5.41,95%CI=1.80~16.27,P=0.003)和吻合口漏(OR=4.44,95%CI=1.15~17.09,P=0.030)是形成永久性造口的独立危险因素。结论:目前仍有部分患者的预防性临时造口无法还纳而形成永久性造口。永久性造口与肿瘤位置过低、初诊时存在远处器官转移和出现吻合口漏密切相关。Background and Aims:Preventive temporary stoma has been widely used in surgeries for rectal cancer as a simple and effective method to reduce the severity of postoperative anastomotic leakage.However,some patients with preventive temporary stomas cannot undergo reversal due to various factors,resulting in a permanent stoma.Permanent stomas remain a common adverse outcome in clinical practice,and the reasons behind this are not entirely clear.This study analyzes a continuous surgical sample from a single center to explore the risk factors for forming permanent stoma.Methods:The clinical data of patients who underwent anal-preserving rectal cancer surgery with preventive temporary stoma in Gastrointestinal Cancer CenterⅢof Peking University Cancer Hospital from January 2020 to March 2023,with over 12 months of follow-up,were retrospectively collected.The occurrence of permanent stoma was analyzed,and the clinical variables of patients with permanent stoma were compared to those who underwent stoma reversal,along with an analysis of the risk factors for permanent stoma formation.Permanent stoma was defined as ostomy reversal failure for more than 12 months.Results:A total of 299 patients were included,among which 268(89.63%)underwent stoma reversal(stoma closure group),and 31(10.37%)did not(permanent stoma group).Compared to the stoma closure group,the permanent stoma group had a higher incidence of distant organ metastasis at diagnosis(7.5%vs.25.85%,P=0.003)and also had higher proportions of T3 and T4 stages,N2 stage,and clinical stageⅣ(all P<0.05)with an elevated overall postoperative complication rate(19.0%vs.41.9%,P=0.003)as well as a higher rate of severe complications(1.1%vs.9.7%,P=0.016)and an increased incidence of anastomotic leakage(4.9%vs.19.4%,P=0.006).Logistic regression analysis revealed that the presence of distant organ metastasis at diagnosis(OR=5.41,95%CI=1.80-16.27,P=0.003),and occurrence of anastomotic leakage(OR=4.44,95%CI=1.15-17.09,P=0.030)were independent risk factors for the formation of
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