Colon and Rectal Surgery, Creighton University Medical Center, Omaha, NE, USA.
Am J Surg. 2009 Dec;198(6):765-70. doi: 10.1016/j.amjsurg.2009.05.024.
The aim of this study was to assess the rate of permanent diversion in patients undergoing coloanal anastomosis after neoadjuvant therapy for rectal cancer.
We performed a retrospective review of patients with rectal cancer who underwent a total mesorectal excision of a tumor within 9 cm of the anal verge.
There were 201 patients who underwent resection with coloanal anastomosis, with a mean follow-up period of 51 months. The average tumor distance from the anal verge was 7 cm (range, 4-9 cm). Neoadjuvant therapy was administrated in 145 patients, 47 had no radiation, and 9 received radiation postoperatively. Thirty-two patients (16%) had long-term complications including incontinence, fistulas, and strictures. Twenty-five patients (12%) had recurrent disease, 16 of these were local recurrence. The total rate of permanent diversion was 29 (14%). Reasons for diversion included local recurrence in 12 patients (6%), complications in 10 patients (5%), and poor function in 7 patients (3%).
Poor bowel function, late complications, and local recurrence all contribute to permanent diversion after a coloanal anastomosis. Neoadjuvant therapy in conjunction with a total mesorectal excision and coloanal anastomosis leads to acceptably low permanent diversion rates in the vast majority of patients.
本研究旨在评估接受新辅助治疗的直肠癌患者行结肠肛管吻合术后永久性转流的发生率。
我们对距离肛缘 9cm 以内接受全直肠系膜切除术的直肠癌患者进行了回顾性研究。
共有 201 例患者接受了结肠肛管吻合术切除，平均随访时间为 51 个月。肿瘤距肛缘的平均距离为 7cm（范围 4-9cm）。145 例患者接受了新辅助治疗，47 例未接受放疗，9 例术后接受了放疗。32 例（16%）出现长期并发症，包括失禁、瘘管和狭窄。25 例（12%）患者出现疾病复发，其中 16 例为局部复发。永久性转流的总发生率为 29%（14%）。转流的原因包括 12 例（6%）局部复发、10 例（5%）并发症和 7 例（3%）功能不佳。
结肠肛管吻合术后永久性转流的原因包括肠道功能不佳、晚期并发症和局部复发。新辅助治疗联合全直肠系膜切除术和结肠肛管吻合术可使绝大多数患者永久性转流率保持在较低水平。
