Department of Colorectal Surgery, First Affiliated Hospital, Zhejiang University, Zhejiang, China.
Dis Colon Rectum. 2014 Nov;57(11):1267-74. doi: 10.1097/DCR.0000000000000217.
Most surgeons suggest the use of fecal diversion in patients undergoing low anterior resections of rectal tumors at high risk for anastomotic leakage. We describe an exploratory study to evaluate the efficacy and safety of a new diversion method called a spontaneously closing cannula ileostomy, which was designed to protect rectal anastomoses in patients at high risk for anastomotic leakage. The outcomes of patients treated with cannula ileostomy were compared to those of patients treated with loop ileostomy.
Outcomes included the rates of anastomotic leakage, reoperation and other complications, as well as length of hospital stay and cost.
From January 2011 to December 2012, 294 patients undergoing low colorectal or coloanal anastomosis were treated with ileum diversion using cannula ileostomy or traditional loop ileostomy. Demographics, clinical features, and operational data were recorded.
The anastomotic leakage rates were 8.1% (12/149) in the cannula ileostomy group and 8.3% (12/145) in the loop ileostomy group (p = 1.0). The reoperation rate was 3% (4/149) in patients treated with a cannula ileostomy and 3.4% (5/145) in those who underwent a loop ileostomy (p = 0.75). The median length of the hospital stay was 8.6 days in the cannula ileostomy group and 17.1 days (p < 0.01) in the loop ileostomy group, including time for the initial and reversal operations. In the cannula ileostomy group, the median time to defecation from the anus was 16.5 days after the operation. During the follow-up period, 13 patients in the loop ileostomy group retained their stoma, as compared to 2 in the cannula ileostomy group (p < 0.01).
This study was a nonrandomized design and lacked contrast enema data to identify anastomotic leaks.
Cannula ileostomy is a safe and effective diverting technique that protects low colorectal and coloanal anastomoses. Patients receiving a cannula ileostomy had shorter hospital stays and lower rates of permanent stoma than those receiving a loop ileostomy.
大多数外科医生建议在直肠肿瘤低位前切除术的高危吻合口漏患者中使用粪便分流。我们描述了一项探索性研究，以评估一种名为自动闭合套管造口术的新分流方法的疗效和安全性，该方法旨在保护高危吻合口漏患者的直肠吻合口。套管造口术治疗患者的结局与传统的回肠造口术治疗患者的结局进行了比较。
结局包括吻合口漏、再次手术和其他并发症的发生率，以及住院时间和费用。
2011 年 1 月至 2012 年 12 月，294 例接受低位结直肠或结肛吻合术的患者采用套管造口术或传统回肠造口术进行回肠分流。记录患者的人口统计学、临床特征和手术数据。
套管造口组吻合口漏发生率为 8.1%（12/149），回肠造口组为 8.3%（12/145）（p=1.0）。套管造口组再手术率为 3%（4/149），回肠造口组为 3.4%（5/145）（p=0.75）。套管造口组的中位住院时间为 8.6 天，回肠造口组为 17.1 天（p<0.01），包括初始和逆转手术时间。在套管造口组中，术后肛门排便的中位时间为 16.5 天。在随访期间，回肠造口组中有 13 例患者保留了造口，而套管造口组中只有 2 例（p<0.01）。
本研究为非随机设计，缺乏对比造影数据来确定吻合口漏。
套管造口术是一种安全有效的分流技术，可保护低位结直肠和结肛吻合口。接受套管造口术的患者住院时间更短，永久性造口率低于接受回肠造口术的患者。
