Karanjia N D, Corder A P, Holdsworth P J, Heald R J
Colorectal Research Unit, Basingstoke District Hospital, Hampshire, UK.
Br J Surg. 1991 Feb;78(2):196-8. doi: 10.1002/bjs.1800780221.
The aim of this study was to investigate the need to defunction the low anastomosis after anterior resection of the rectum with total mesorectal excision for rectal cancer. Two hundred consecutive patients (125 defunctioned, 75 non-defunctioned) undergoing low anterior resection for carcinoma were included in the study. Peritonitis requiring emergency laparotomy occurred in 8 per cent of the patients who did not have a defunctioning stoma compared with less than 1 per cent of those patients who had a defunctioning stoma (P less than 0.01). There was no mortality related to closure of the stoma but seven patients developed a faecal fistula and ten developed an incisional hernia. Despite current trends to avoid the defunctioning stoma, these results suggest that after total mesorectal excision the faecal stream should be temporarily diverted away from the anastomosis that is 6 cm or less from the anal verge to protect against potentially life-threatening anastomotic leakage.
本研究的目的是探讨在直肠癌全直肠系膜切除术后低位吻合口是否需要进行转流造口。本研究纳入了200例连续接受低位前切除术治疗癌肿的患者（125例进行了转流造口，75例未进行转流造口）。未行转流造口的患者中，8%发生了需要急诊剖腹手术的腹膜炎，而行转流造口的患者中这一比例不到1%（P<0.01）。造口关闭未导致死亡，但有7例患者发生粪瘘，10例患者发生切口疝。尽管目前有避免行转流造口的趋势，但这些结果表明，在全直肠系膜切除术后，对于距肛缘6 cm或更短距离的吻合口，应暂时将粪便流从吻合口转流，以防止可能危及生命的吻合口漏。
