Miura Takuya, Sakamoto Yoshiyuki, Morohashi Hajime, Yoshida Tatsuya, Sato Kentaro, Hakamada Kenichi
Department of Gastroenterological Surgery Hirosaki University Graduate School of Medicine Hirosaki Japan.
Ann Gastroenterol Surg. 2017 Aug 31;2(1):79-86. doi: 10.1002/ags3.12033. eCollection 2018 Jan.
The goal of the present study was to evaluate permanent stoma formation and defecation function in long-term follow up after surgery for low rectal cancer without a diverting stoma. Subjects were 275 patients who underwent sphincter-preserving surgery for low rectal cancer between 2000 and 2012. Clinical outcomes were evaluated and defecation function was assessed based on a questionnaire survey, using Wexner and modified fecal incontinence quality of life (mFIQL) scores. Incidence of anastomotic leakage was 21.8%, and surgery-related death as a result of anastomotic leakage occurred in one male patient. Median follow-up period was 4.9 years and permanent stoma formation rate was 16.7%. Anastomotic leakage was an independent predictor of permanent stoma formation (odds ratio [OR] 5.86, <0.001). Age <65 years (OR 1.99, =0.001) and male gender (OR 4.36, =0.026) were independent predictors of anastomotic leakage. A permanent stoma was formed as a result of poor healing of anastomotic leakage in 29.6% of males, but in no females. Defecation function was surveyed in 27 and 116 patients with and without anastomotic leakage, respectively. These groups had no significant differences in median follow-up period (63.5 vs 63 months), Wexner scores (quartile) (6 (2.5-9) vs 6 (3-11)), and mFIQL scores (26.1 (4.8-64.2) vs 23.8 (5.9-60.7). Defecation function associated with anastomotic leakage showed no significant dependence on gender or resection procedure. Sphincter-preserving surgery without a diverting stoma may be indicated for females with low rectal cancer. In this procedure, male gender is a risk factor for anastomotic leakage and subsequent formation of a permanent stoma in one in three patients.
本研究的目的是评估低位直肠癌手术未行转流造口的长期随访中永久性造口形成情况及排便功能。研究对象为2000年至2012年间接受低位直肠癌保肛手术的275例患者。基于问卷调查，采用韦克斯纳（Wexner）评分和改良的大便失禁生活质量（mFIQL）评分对临床结局进行评估并评价排便功能。吻合口漏发生率为21.8%，1例男性患者因吻合口漏导致手术相关死亡。中位随访期为4.9年，永久性造口形成率为16.7%。吻合口漏是永久性造口形成的独立预测因素（比值比[OR] 5.86，<0.001）。年龄<65岁（OR 1.99，=0.001）和男性（OR 4.36，=0.026）是吻合口漏的独立预测因素。29.6%的男性因吻合口漏愈合不良形成永久性造口，而女性无一例。分别对27例有吻合口漏和116例无吻合口漏的患者进行了排便功能调查。这些组在中位随访期（63.5个月对63个月）、韦克斯纳评分（四分位数）（6（2.5 - 9）对6（3 - 11））和mFIQL评分（26.1（4.8 - 64.2）对23.8（5.9 - 60.7））方面无显著差异。与吻合口漏相关的排便功能对性别或切除手术方式无明显依赖性。对于低位直肠癌女性患者，可考虑不行转流造口的保肛手术。在此手术中，男性是吻合口漏及随后三分之一患者形成永久性造口的危险因素。
