腹腔镜低位前切除术不预防性造口：日本单中心回顾性研究。
Diverting Stoma No Diversion in Laparoscopic Low Anterior Resection: A Single-center Retrospective Study in Japan.
机构信息
Division of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
Division of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
出版信息
In Vivo. 2019 Nov-Dec;33(6):2125-2131. doi: 10.21873/invivo.11713.
Abstract
BACKGROUND/AIM: The purpose of this retrospective study was to describe the benefits and risks of a diverting stoma (DS) in laparoscopic low anterior resection (LAR) for rectal cancer.
MATERIALS AND METHODS
A total of 140 and 167 patients without and with DS, respectively, were included in this study in a high-volume cancer center of Japan within an 8-year period.
RESULTS
Small bowel obstruction occurred more frequently in patients with DS (2.86% vs. 16.17%, p<0.001). The difference in anastomotic leakage rate was not statistically significant (11.43% vs. 10.18%, p=0.72). In multivariate analysis, the operating time was associated with a higher rate of leakage in LAR [odds ratio (OR) 8.772, 95% confidence interval (CI)=1.002-1.012, p=0.027].
CONCLUSION
Operating time was associated with a higher rate of leakage in LAR for low rectal cancer. A DS did not reduce anastomotic leakage but increased the risk of postoperative intestinal obstruction in laparoscopic LAR.
摘要
背景/目的：本回顾性研究的目的是描述直肠低位前切除术（LAR）中预防性造口（DS）的获益和风险。
材料和方法
在日本一个 8 年期间的大容量癌症中心，共纳入了 140 例无预防性造口和 167 例有预防性造口的患者。
结果
DS 组小肠梗阻的发生率更高（2.86%比 16.17%，p<0.001）。吻合口漏的发生率差异无统计学意义（11.43%比 10.18%，p=0.72）。多因素分析显示，LAR 中手术时间与漏的发生率较高相关（比值比 8.772，95%置信区间 1.002-1.012，p=0.027）。
结论
对于低位直肠肿瘤，LAR 中手术时间与漏的发生率较高相关。DS 并不能降低吻合口漏，但增加了腹腔镜 LAR 后肠梗阻的风险。
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