Zhen Li, Wang Yanan, Zhang Ze, Wu Tongwei, Liu Ruoyan, Li Tingting, Zhao Liying, Deng Haijun, Qi Xiaolong, Li Guoxin
Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Head and Neck Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
Curr Probl Cancer. 2017 May-Jun;41(3):231-240. doi: 10.1016/j.currproblcancer.2017.02.007. Epub 2017 Mar 2.
A temporary stoma is often used in rectal cancer surgery to protect a distal anastomosis, which remains a major concern after rectal cancer surgery, particularly after low anterior resection. The temporary stoma is scheduled for closure. However, the optimal time of closure of the protecting stoma remains unclear because of sparse studies and data. We aimed to detect the efficacy between early and late temporary ileostomy closure in patients with rectal cancer during or after neoadjuvant chemoradiotherapy. We conducted a prospective, 2-group design between early and late ileostomy closure group in patients after rectal cancer surgery with temporary stoma. Participants were recruited in a teaching hospital in Guangzhou, China. A total of 161 patients confirmed diagnosis of rectal cancer underwent curative surgery and temporary ileostomy. Participants with temporary ileostomy received closure surgery after 1 (early) or 6 (late) months were assessed by clinical parameters and quality of life. Patients in late closure group received more adjuvant chemotherapy cycles but with comparable incidence of stoma closure-related complications and length of hospital stay compared to early closure group. Participants in late closure group with standardized postoperative chemotherapy might have a better prognosis compared with those in early closure group. An increased emphasis should be given to choose the optimal closure time of patients with rectal cancer having temporary ileostomy. Colorectal nurses could provide support to physician for observation of prognosis of different closure time.
临时造口常用于直肠癌手术以保护远端吻合口，这仍是直肠癌手术后的主要关注点，尤其是在低位前切除术后。临时造口计划关闭。然而，由于研究和数据稀少，保护造口的最佳关闭时间仍不明确。我们旨在检测新辅助放化疗期间或之后直肠癌患者早期和晚期临时回肠造口关闭的效果。我们对有临时造口的直肠癌手术后患者进行了早期和晚期回肠造口关闭组的前瞻性两组设计。在中国广州的一家教学医院招募参与者。共有161例确诊为直肠癌的患者接受了根治性手术和临时回肠造口术。接受临时回肠造口术的参与者在1个月（早期）或6个月（晚期）后接受关闭手术，并通过临床参数和生活质量进行评估。与早期关闭组相比，晚期关闭组的患者接受了更多周期的辅助化疗，但造口关闭相关并发症的发生率和住院时间相当。与早期关闭组相比，接受标准化术后化疗的晚期关闭组参与者可能预后更好。应更加重视为有临时回肠造口的直肠癌患者选择最佳关闭时间。结直肠科护士可以为医生提供支持，以观察不同关闭时间的预后情况。
