Bhangu A, Tiramula R
Department of Colorectal Surgery, Good Hope Hospital, Birmingham, UK.
Minerva Chir. 2011 Feb;66(1):49-54.
The aim of this study was to determine whether neoadjuvant therapy delays the closure of loop ileostomy after anterior resection.
Review of 45 patients with loop ileostomies formed at elective surgery from 2006- 2008. T-tests and Kaplan Meier survival analysis were used.
At a mean follow-up of 470 days 71% (N.=32) of patients have had their ileostomy closed. Of these, 27% (N.=12, group A) proceeded straight to surgery and 63% (N.=20, group B) received neoadjuvant therapy (long course chemoradiotherapy N.=13, short course radiotherapy N.=7). There was no significant difference in time to closure between groups (group A 181 days [range 98-296]; group B was 202 days [range 98-310], P=0.416). Those with Dukes C/D disease had a longer time to closure than those with A/B (P=0.002), likely due to higher complication rates in those with Dukes C/D disease (9/20 versus 4/25, P=0.049, respectively). Cox's regression analysis showed that only Dukes C/D stage was predictive of a longer time to closure (hazard ratio 3.289, 1.509-7.170, P=0.001).
Time to closure of loop ileostomy was not delayed by neoadjuvant therapies. Patients with Dukes C/D disease should be warned about risk of longer time to closure.
本研究旨在确定新辅助治疗是否会延迟前切除术术后袢式回肠造口的闭合。
回顾2006年至2008年择期手术中形成袢式回肠造口的45例患者。采用t检验和Kaplan-Meier生存分析。
平均随访470天时，71%（n = 32）的患者回肠造口已闭合。其中，27%（n = 12，A组）直接进行手术，63%（n = 20，B组）接受新辅助治疗（长程放化疗n = 13，短程放疗n = 7）。两组之间闭合时间无显著差异（A组181天[范围98 - 296]；B组为202天[范围98 - 310]，P = 0.416）。Dukes C/D期患者的闭合时间比A/B期患者长（P = 0.002），可能是由于Dukes C/D期患者的并发症发生率较高（分别为9/20和4/25，P = 0.049）。Cox回归分析显示，只有Dukes C/D期可预测闭合时间延长（风险比3.289，1.509 - 7.170，P = 0.001）。
新辅助治疗不会延迟袢式回肠造口的闭合时间。应告知Dukes C/D期患者闭合时间延长的风险。
