Alves A, Panis Y, Lelong B, Dousset B, Benoist S, Vicaut E
Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France.
Br J Surg. 2008 Jun;95(6):693-8. doi: 10.1002/bjs.6212.
Temporary faecal diversion is recommended with a low colorectal, coloanal or ileoanal anastomosis (LA). This randomized study evaluated early (EC; 8 days) versus late (LC; 2 months) closure of the temporary stoma.
Patients undergoing rectal resection with LA were eligible to participate. If there was no radiological sign of anastomotic leakage after 7 days, patients were randomized to EC or LC. The primary endpoints were postoperative morbidity and mortality 90 days after the initial resection.
Some 186 patients were analysed. There were no deaths within 90 days and overall morbidity rates were similar in the EC and LC groups (31 versus 38 per cent respectively; P = 0.254). Overall surgical complication (both 15 per cent; P = 1.000) and reoperation (both 8 per cent; P = 1.000) rates were similar, but wound complications were more frequent after EC (19 versus 5 per cent; P = 0.007). Small bowel obstruction (3 versus 16 per cent; P = 0.002) and medical complications (5 versus 15 per cent; P = 0.021) were more common with LC. Median (range) hospital stay was reduced by EC (16 (6-59) versus 18 (9-262) days; P = 0.013).
Early stoma closure is feasible in selected patients, with reduced hospital stay, bowel obstruction and medical complications, but a higher wound complication rate.
NCT00428636 (http://www.clinicaltrials.gov).
对于低位结直肠、结肠肛管或回肠肛管吻合术（LA），建议进行临时性粪便转流。这项随机研究评估了临时性造口早期（EC；8天）关闭与晚期（LC；2个月）关闭的情况。
接受LA直肠切除术的患者符合参与条件。如果7天后没有吻合口漏的放射学征象，患者被随机分为EC组或LC组。主要终点是初次切除术后90天的术后发病率和死亡率。
共分析了约186例患者。90天内无死亡病例，EC组和LC组的总体发病率相似（分别为31%和38%；P = 0.254）。总体手术并发症（均为15%；P = 1.000）和再次手术率（均为8%；P = 1.000）相似，但EC组伤口并发症更常见（19%对5%；P = 0.007）。LC组小肠梗阻（3%对16%；P = 0.002）和内科并发症（5%对15%；P = 0.021）更常见。EC组的中位（范围）住院时间缩短（16（6 - 59）天对18（9 - 262）天；P = 0.013）。
对于部分患者，早期造口关闭是可行的，可缩短住院时间、减少肠梗阻和内科并发症，但伤口并发症发生率较高。
NCT00428636（http://www.clinicaltrials.gov）
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