Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Colorectal Dis. 2020 Dec;22(12):2098-2104. doi: 10.1111/codi.15364. Epub 2020 Oct 24.
Low anterior resection of the rectum for cancer (LAR) entails a risk of symptomatic anastomotic leakage as well as impaired anorectal function, both of which may eventually result in the need for a permanent stoma (PS). The aim was to investigate the incidence of and risk factors for PS beyond 5 years following LAR.
Patients undergoing LAR and included in a multicentre trial with randomization to defunctioning stoma or not were followed for a median of 15 years. The reasons for a PS up to 5 years (PS ≤ 5 years) and beyond 5 years (PS > 5 years) were identified and compared. Risk factors for PS were analysed.
Of all patients, 25% (57/232) had a PS. PS ≤ 5 years occurred in 19% (44/232) at a median of 12.5 months and PS > 5 years in 6% (13/232) at a median of 118 months following LAR. The main reason for PS ≤ 5 years was impaired anorectal function in 55% (24/44) and the main reason for PS > 5 years was pelvic sepsis related to the colorectal anastomosis in 46% (6/13). The major risk factor for PS was symptomatic anastomotic leakage, which occurred in 56% (32/57) of patients with PS and 10% (17/175) of patients without PS (P < 0.001).
One-fourth of the patients who ended up with a PS had it fashioned beyond 5 years at a median of 10 years following LAR. Symptomatic anastomotic leakage was the major risk factor for PS, and impaired anorectal function was the main overall reason for a PS.
直肠癌低位前切除术（LAR）存在吻合口漏的症状和肛肠功能受损的风险，这两种情况最终可能需要永久性造口（PS）。本研究旨在探讨 LAR 术后 5 年以上 PS 的发生率和危险因素。
对接受 LAR 并随机分组是否行预防性造口的多中心试验患者进行中位随访 15 年。确定并比较了 5 年内（PS ≤ 5 年）和 5 年以上（PS > 5 年）行 PS 的原因。分析了 PS 的危险因素。
所有患者中有 25%（57/232）行 PS。PS ≤ 5 年的发生率为 19%（44/232），中位时间为 12.5 个月；PS > 5 年的发生率为 6%（13/232），中位时间为 118 个月。PS ≤ 5 年的主要原因是肛肠功能受损（55%，24/44），PS > 5 年的主要原因是与结直肠吻合口相关的盆腔感染（46%，6/13）。PS 的主要危险因素是有症状的吻合口漏，PS 组中有 56%（32/57）的患者和无 PS 组中有 10%（17/175）的患者发生（P < 0.001）。
四分之一的 PS 患者在 LAR 后中位时间 10 年以上时需要行 PS。有症状的吻合口漏是 PS 的主要危险因素，肛肠功能受损是 PS 的主要总体原因。
