不同分期低位直肠癌患者行腹腔镜预防性回肠造口术后造口永久化发生率的比较及原因分析  

Incidence comparison and cause analysis of stoma permanency after laparoscopic preventive ileostomy in patients with low rectal cancer in different stages

作　　者：李瓒 周义 梁鹏 LI Zan;ZHOU Yi;LIANG Peng(Department of General Surgery,Guangyuan Hospital of Traditional Chinese Medicine,Guangyuan 628000,China;Department of Gastroenterology,Guangyuan Central Hospital)

机构地区：[1]广元市中医医院普通外科,四川广元628000 [2]广元市中心医院消化内科

出　　处：《腹腔镜外科杂志》2025年第1期43-48,共6页Journal of Laparoscopic Surgery

摘　　要：目的:探讨不同分期低位直肠癌患者行腹腔镜预防性回肠造口术后造口永久化的发生率及原因。方法:选择2016年8月至2022年7月接受预防性回肠造口的228例低位直肠癌患者,根据术后1年造口还纳情况分为造口还纳组(n=175)与造口永久化组(n=53)。对比分析两组临床资料,多因素Logistic回归分析影响造口永久化的因素,并构建回归方程与预测模型。结果:两组TNM分期、造口旁疝、吻合口狭窄、吻合口漏、局部复发与远处转移率差异有统计学意义(P<0.05)。TNM分期(Ⅲ期)吻合口狭窄、吻合口漏、局部复发与远处转移是导致预防性回肠造口由临时性转为永久化的独立影响因素(P<0.05)。造口永久化预测模型曲线下面积为0.947(95%CI=0.920~0.973,P<0.001),具有较高的区分度与准确度,且当P=0.80时,预测一致率最高。结论:不同分期低位直肠癌患者行预防性回肠造口术后,造口还纳率随肿瘤分期的升高而降低。吻合口狭窄、吻合口漏、局部复发与远处转移的患者术后造口永久化的风险更高。Objective:To explore the incidence and causes of stoma permanency after laparoscopic preventive ileostomy in p atients with low rectal cancer in different stages.Methods:A total of 228 patients with low rectal cancer who underwent preventive ileostomy between Aug.2016 and Jul.2022 were included in this study.Based on stoma reversal status at 1 year postoperatively,patients were divided into the stoma reversal group(n=175)and the permanent stoma group(n=53).Clinical data were compared between the two groups.The multivariate logistic regression analysis was used to analyze the factors affecting stoma permanency,and a regression e quation and prediction model were established.Results:There were statistically significant differences in TNM stage,parastomal hernia,anastomotic stenosis,anastomotic leakage,local recurrence and distant metastasis between the two groups(P<0.05).TNM stageⅢ,anastomotic s tenosis,anastomotic leakage,local recurrence,and distant metastasis were independent factors associated with the conversion of preventive stomas from temporary to permanent(P<0.05).The area under curve value of the stoma permanent prediction model was 0.947(95%CI=0.920~0.973,P<0.001),demonstrating high differentiation and accuracy,and the prediction agreement rate was the highest when P=0.80.Conclusions:After preventive ileostomy in patients with different stages of low rectal cancer,the rate of stoma reversal decreases with the increase of tumor stage.Patients with anastomotic stenosis,anastomotic leakage,local recurrence and/or distant metastasis have a significantly higher risk of postoperative stoma permanency.

关 键 词：低位直肠肿瘤 腹腔镜检查 预防性回肠造口 造口永久化 影响因素分析 

分 类 号：R735.37[医药卫生—肿瘤]