Rutegård Martin, Boström Petrus, Haapamäki Markku, Matthiessen Peter, Rutegård Jörgen
Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Int J Colorectal Dis. 2016 Mar;31(3):579-85. doi: 10.1007/s00384-015-2465-6. Epub 2015 Dec 15.
A diverting stoma is commonly used to reduce the risk of anastomotic leakage when performing total mesorectal excision (TME) in anterior resection for rectal cancer. The purpose of this study was to evaluate the impact of fecal diversion in relation to partial mesorectal excision (PME).
A retrospective analysis was undertaken on a national cohort, originally created to study the impact of central arterial ligation on patients with increased cardiovascular risk. Some 741 patients operated with anterior resection for rectal cancer during the years 2007 through 2010 were followed up for 53 months. Multivariate logistic regression was used to evaluate the impact of diverting stoma on the risk of anastomotic leakage and permanent stoma, expressed as odds ratios (ORs) and 95% confidence intervals (CIs).
The risk of anastomotic leakage was increased in TME surgery when not using a diverting stoma (OR 5.1; 95% CI 2.2-11.6), while the corresponding risk increase in PME patients was modest (OR 1.8; 95% CI 0.8-4.0). At study completion or death, 26 and 13% of TME and PME patients, respectively, had a permanent stoma. A diverting stoma was a statistically significant risk factor for a permanent stoma in PME patients (OR 4.7; 95% CI 2.5-9.0), while less important in TME patients (OR 1.8; 95% CI 0.6-5.5).
The benefit of a diverting stoma concerning anastomotic leakage in this patient group seems doubtful. Moreover, the diverting stoma itself may contribute to the high rate of permanent stomas.
在直肠癌前切除术行全直肠系膜切除（TME）时，转流造口常用于降低吻合口漏的风险。本研究的目的是评估粪便转流对部分直肠系膜切除（PME）的影响。
对一个全国性队列进行回顾性分析，该队列最初是为研究中心动脉结扎对心血管风险增加患者的影响而设立的。对2007年至2010年期间接受直肠癌前切除术的约741例患者进行了53个月的随访。采用多因素逻辑回归评估转流造口对吻合口漏风险和永久性造口的影响，以比值比（OR）和95%置信区间（CI）表示。
TME手术中不使用转流造口时吻合口漏的风险增加（OR 5.1；95%CI 2.2 - 11.6），而PME患者相应的风险增加幅度较小（OR 1.8；95%CI 0.8 - 4.0）。在研究结束或死亡时，TME和PME患者分别有26%和13%有永久性造口。转流造口是PME患者永久性造口的一个具有统计学意义的风险因素（OR 4.7；95%CI 2.5 - 9.0），而在TME患者中重要性较低（OR 1.8；95%CI 0.6 - 5.5）。
在该患者群体中转流造口对吻合口漏的益处似乎值得怀疑。此外，转流造口本身可能导致永久性造口的高发生率。
