Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
Colorectal Dis. 2017 Dec;19(12):1067-1075. doi: 10.1111/codi.13771.
Fashioning a defunctioning stoma is common when performing an anterior resection for rectal cancer in order to avoid and mitigate the consequences of an anastomotic leakage. We investigated the permanent stoma prevalence, factors influencing stoma outcome and complication rates following stoma reversal surgery.
Patients who had undergone an anterior resection for rectal cancer between 2007 and 2013 in the northern healthcare region were identified using the Swedish Colorectal Cancer Registry and were followed until the end of 2014 regarding stoma outcome. Data were retrieved by a review of medical records. Multiple logistic regression was used to evaluate predefined risk factors for stoma permanence. Risk factors for non-reversal of a defunctioning stoma were also analysed, using Cox proportional-hazards regression.
A total of 316 patients who underwent anterior resection were included, of whom 274 (87%) were defunctioned primarily. At the end of the follow-up period 24% had a permanent stoma, and 9% of patients who underwent reversal of a stoma experienced major complications requiring a return to theatre, need for intensive care or mortality. Anastomotic leakage and tumour Stage IV were significant risk factors for stoma permanence. In this series, partial mesorectal excision correlated with a stoma-free outcome. Non-reversal was considerably more prevalent among patients with leakage and Stage IV; Stage III patients at first had a decreased reversal rate, which increased after the initial year of surgery.
Stoma permanence is common after anterior resection, while anastomotic leakage and advanced tumour stage decrease the chances of a stoma-free outcome. Stoma reversal surgery entails a significant risk of major complications.
在进行直肠癌前切除术时，为了避免和减轻吻合口漏的后果，通常会形成一个临时性造口。我们研究了永久性造口的流行率、影响造口结局的因素以及造口反转手术后的并发症发生率。
使用瑞典结直肠癌登记处，确定了 2007 年至 2013 年间在北部医疗保健区接受直肠癌前切除术的患者，并在 2014 年底前对造口结局进行随访。通过审查病历获取数据。使用多因素逻辑回归评估永久性造口的预设风险因素。使用 Cox 比例风险回归分析非功能性造口反转的风险因素。
共纳入 316 例接受前切除术的患者，其中 274 例（87%）患者行原发性造口。在随访结束时，24%的患者有永久性造口，9%的接受造口反转的患者发生了需要返回手术室、需要重症监护或死亡的主要并发症。吻合口漏和肿瘤 IV 期是造口永久性的显著危险因素。在本系列中，部分直肠系膜切除术与无造口结局相关。吻合口漏和 IV 期患者的非反转更为常见；III 期患者最初的反转率较低，但在手术后的最初一年后增加。
前切除术后永久性造口很常见，而吻合口漏和晚期肿瘤阶段降低了无造口结局的机会。造口反转手术存在严重并发症的风险。
