Department of Colorectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Int J Colorectal Dis. 2012 Oct;27(10):1259-66. doi: 10.1007/s00384-012-1423-9. Epub 2012 Feb 16.
The objective of this study is to identify rates and factors associated with permanent diversion following restorative proctosigmoidectomy for rectal cancer when complicated by an anastomotic leak.
This study is a retrospective review.
The setting of this study is a tertiary referral hospital
Patients involved in this study were those who underwent restorative rectal cancer surgery from 1997 through 2008 identified from an institutional cancer database.
No interventions were performed in this study.
Factors associated with time to ostomy closure and rates of permanent diversion following anastomotic leaks
One hundred and thirty patients (mean age 59.7 years) were identified, 111 (85%) of whom had stoma diversion at the index surgery. Asymptomatic occult radiological leaks occurred in 52 patients (40%). Seventy-eight patients (60%) underwent ultimate ostomy closure at a median time of 6.3 months after the index surgery, which was not significantly affected by previous radiotherapy (p = 0.08). Twelve patients (9%) underwent anastomotic reconstruction. Pathologic stage II or greater (OR 4.42; 1.95-10.04), symptomatic presentation (OR 4.13; 1.86-9.19) and anastomotic disruption >5 mm (OR 4.42; 2.01-9.74) were independently associated with permanent diversion. Among all survivors, 33% did not have their ostomy reversed. Stoma diversion constructed after leak detection in 19 patients (15%) did not affect permanent stoma rate (OR 0.86; 0.31-2.34) or time to stoma closure (p = 0.29).
The majority of anastomotic leaks after restorative rectal cancer surgery can be salvaged without anastomotic reconstruction. However, in one third of the patients, an anastomotic leak results in a permanent stoma.
本研究旨在确定直肠癌保肛直肠切除术吻合口漏时永久性转流的发生率和相关因素。
本研究为回顾性研究。
本研究地点为一家三级转诊医院。
本研究涉及的患者为 1997 年至 2008 年通过机构癌症数据库接受保肛直肠癌手术的患者。
本研究未进行任何干预。
吻合口漏后永久性转流的相关因素及造口关闭时间。
共确定 130 例患者（平均年龄 59.7 岁），其中 111 例（85%）在指数手术时行造口转流。52 例（40%）患者无症状隐匿性放射学漏。78 例（60%）患者最终在指数手术后中位时间 6.3 个月行造口关闭，但这与先前放疗无显著相关性（p=0.08）。12 例（9%）患者行吻合口重建。病理分期 II 期或更高级别（OR 4.42；1.95-10.04）、有症状表现（OR 4.13；1.86-9.19）和吻合口破裂>5mm（OR 4.42；2.01-9.74）与永久性转流独立相关。所有幸存者中，33%未行造口还纳。在 19 例（15%）漏诊后行造口转流的患者中，永久性造口率（OR 0.86；0.31-2.34）或造口关闭时间（p=0.29）无显著差异。
直肠癌保肛直肠切除术后大多数吻合口漏可通过吻合口重建来挽救，但三分之一的患者吻合口漏导致永久性造口。
