Division of Colorectal Surgery, Shizuoka Cancer Center Hospital, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan.
Colorectal Dis. 2011 Dec;13(12):1384-9. doi: 10.1111/j.1463-1318.2010.02481.x.
The aim of the study was to determine the present state of diverting stoma construction in Japanese cancer centres and to investigate the relationship between symptomatic leakage and diverting stoma after low anterior resection for rectal cancer.
Two hundred and twenty-two consecutive patients undergoing low anterior resection for rectal cancer located within 10 cm from the anal verge were investigated in a prospective, multicenter study.
The overall leakage rate was 9.0% (20/222). Of 31 cases with an anastomosis within 2.0 cm from the anal verge, 22 (71%) had a diverting stoma. Of cases anastomosed within 5.0 cm, the absence of a diverting stoma and tumour size were significantly related to an increased rate of leakage [leakage in 13 (12.7%) of 102 cases without a diverting stoma; in three (3.8%) of 80 cases with a diverting stoma]. Among anastomoses within 2.0 cm from the anal verge, leakage occurred in four (44.4%) of nine cases without and in none (0%) of 22 cases with a diverting stoma.
We recommend a diverting stoma for an anastomosis within 5.0 cm of the anal verge and strongly recommend it for a very low anastomosis within 2.0 cm.
本研究旨在确定日本癌症中心的转流造口术现状，并调查低位前切除术治疗直肠癌后症状性渗漏与转流造口之间的关系。
对 222 例连续接受距肛门 10cm 以内低位前切除术治疗的直肠癌患者进行前瞻性多中心研究。
总的渗漏率为 9.0%（20/222）。在距肛门 2.0cm 以内吻合的 31 例中，有 22 例（71%）行转流造口术。在距肛门 5.0cm 以内吻合的病例中，无转流造口术和肿瘤大小与渗漏发生率增加显著相关[无转流造口术的 102 例中有 13 例（12.7%）发生渗漏；有转流造口术的 80 例中有 3 例（3.8%）发生渗漏]。在距肛门 2.0cm 以内吻合的病例中，无转流造口术的 9 例中有 4 例（44.4%）发生渗漏，而有转流造口术的 22 例中无一例发生渗漏。
我们建议在距肛门 5.0cm 以内的吻合术行转流造口术，如果吻合术非常接近肛门（2.0cm 以内），强烈建议行转流造口术。
