[直肠癌患者去功能化造口未闭合的相关危险因素：单因素和多因素分析]

[Risk factors associated with non-closure of defunctioning stoma in patients with rectal cancer: univariate and multivariate analysis].

作者信息

Alekseev M V, Shelygin Yu A, Rybakov E G

机构信息

Ryzhikh National Medical Research Centre of Coloproctology, Moscow, Russia.

Russian Medical Academy of Postgraduate Education, Moscow, Russia.

出版信息

Khirurgiia (Mosk). 2021(2):40-47. doi: 10.17116/hirurgia202102140.

DOI:10.17116/hirurgia202102140

PMID:33570353

Abstract

OBJECTIVE

To identify the risk factors associated with non-closure of defunctioning stoma in patients with rectal cancer.

MATERIAL AND METHODS

A retrospective analysis included patients who underwent surgical treatment at the Ryzhikh National Medical Research Centre of Coloproctology for the period from March 2017 to August 2019. Inclusion criterion was anterior or low anterior resection followed by anastomosis and preventive stoma. Univariate and multivariate analysis enrolled 28 factors for identifying the risk factors of non-closure of defunctioning stoma.

RESULTS

There were 246 patients with rectal cancer. Intraoperative fluorescence angiography was applied in 145 cases to assess blood supply within the anastomosis and reduce the risk of anastomotic leakage. According to multivariate analysis, only two factors had significant influence on non-closure of preventive stoma - any grade of anastomotic leakage (OR 6.5; 95% CI 2.2-18.8, =0.001) and rectal cancer stage IV (OR 7.2; 95% CI 1.9-27.6, =0.004).

CONCLUSION

According to our data, permanent stoma is observed in 15% of patients.

摘要

目的

确定直肠癌患者功能性造口未闭合的相关危险因素。

材料与方法

对2017年3月至2019年8月期间在里日赫国家结直肠病医学研究中心接受手术治疗的患者进行回顾性分析。纳入标准为前切除术或低位前切除术，随后进行吻合术和预防性造口术。单因素和多因素分析纳入28个因素，以确定功能性造口未闭合的危险因素。

结果

共有246例直肠癌患者。145例患者术中应用荧光血管造影评估吻合口血供并降低吻合口漏的风险。多因素分析显示，仅两个因素对预防性造口未闭合有显著影响——任何级别的吻合口漏（比值比6.5；95%可信区间2.2 - 18.8，P = 0.001）和直肠癌IV期（比值比7.2；95%可信区间1.9 - 27.6，P = 0.004）。