预防性回肠造口并不能预防直肠癌前切除术后吻合口漏。
Protective ileostomy does not prevent anastomotic leakage after anterior resection of rectal cancer.
机构信息
Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
出版信息
J Int Med Res. 2020 Aug;48(8):300060520946520. doi: 10.1177/0300060520946520.
OBJECTIVE
To explore whether protective ileostomy is beneficial in preventing anastomotic leakage after anterior resection of rectal cancer.
METHODS
A total of 347 patients underwent anterior resection of rectal cancer in our hospital. Ninety-five patients were treated with protective ileostomy (treatment group), and 252 patients were not (control group). The incidences of anastomotic leakage and permanent stoma were compared between the two groups.
RESULTS
The overall incidences of anastomotic leakage were 6.32% (6/95) and 8.73% (22/252) in the treatment group and control group, respectively. In the cohort of patients who underwent neoadjuvant radiotherapy, the incidence of anastomotic leakage was 5.88% (2/34) and 12.0% (3/25) in the treatment group and control group, respectively. Logistic regression showed that the incidence of anastomotic leakage was not statistically significant. However, diabetes and the anastomotic height significantly affected the occurrence of anastomotic leakage. The permanent stoma rate was 6.42% (6/95) and 5.95% (15/252) in the treatment group and control group, respectively.
CONCLUSION
Protective ileostomy did not show a significant advantage in reducing the incidence of postoperative anastomotic leakage in patients with rectal cancer, and it may lead to a permanent stoma.
目的
探讨预防性回肠造口术是否有利于预防直肠癌前切除术后吻合口漏。
方法
回顾性分析我院收治的 347 例行直肠癌前切除术患者的临床资料，95 例行预防性回肠造口术（治疗组），252 例行非预防性回肠造口术（对照组）。比较两组患者吻合口漏和永久性造口的发生率。
结果
治疗组和对照组的吻合口漏总发生率分别为 6.32%（6/95）和 8.73%（22/252）。在接受新辅助放化疗的患者亚组中，治疗组和对照组的吻合口漏发生率分别为 5.88%（2/34）和 12.0%（3/25）。Logistic 回归分析显示，吻合口漏的发生率无统计学意义。然而，糖尿病和吻合口位置显著影响吻合口漏的发生。治疗组和对照组的永久性造口率分别为 6.42%（6/95）和 5.95%（15/252）。
结论
预防性回肠造口术并未显著降低直肠癌患者术后吻合口漏的发生率，且可能导致永久性造口。
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