Division of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
Division of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
In Vivo. 2019 Nov-Dec;33(6):2125-2131. doi: 10.21873/invivo.11713.
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.
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.
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].
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.
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。
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。
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）。
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。
