直肠癌手术中去功能化袢式回肠造口相关的出口梗阻风险
Risk of Outlet Obstruction Associated With Defunctioning Loop Ileostomy in Rectal Cancer Surgery.
作者信息
Enomoto Hiroya, Suwa Katsuhito, Takeuchi Nana, Hannya Yoshito, Tsukazaki Yuhei, Ushigome Takuro, Okamoto Tomoyoshi, Eto Ken
机构信息
Department of Surgery, The Jikei University Daisan Hospital, Komae, Japan.
Department of Surgery, The Jikei University Hospital, Tokyo, Japan.
出版信息
Cancer Diagn Progn. 2021 Nov 3;1(5):465-470. doi: 10.21873/cdp.10062. eCollection 2021 Nov-Dec.
BACKGROUND
The outlet obstruction (OO) rate is 5.4-18.4% after defunctioning ileostomy (DI) following rectal cancer resection to reduce the incidence and severity of anastomotic leakage; OO affects a patient's quality of life and prolongs hospitalization.
PATIENTS AND METHODS
A retrospective analysis was performed of patients who underwent anterior rectal resection and DI for rectal cancer.
RESULTS
Among 100 patients undergoing anterior rectal resection with DI for rectal cancer, 28 (28%) developed OO. Anastomotic leakage and a rectus abdominis muscle thickness ≥10 mm on preoperative computed tomography were significantly associated with the risk of OO in univariate analysis. Multivariate analysis also demonstrated that anastomotic leakage (odds ratio=4.320, 95% confidence interval=1.280-14.60, p=0.019) and rectus abdominis muscle thickness ≥10 mm (odds ratio=3.710, 95% confidence intervaI=1.280-10.70, p=0.016) were significantly risk factors for OO.
CONCLUSION
When OO is observed, an anastomotic leakage should be suspected, especially if there is a high rectus abdominis muscle thickness.
背景
直肠癌切除术后行去功能化回肠造口术（DI）以降低吻合口漏的发生率和严重程度，其出口梗阻（OO）发生率为5.4% - 18.4%；OO会影响患者生活质量并延长住院时间。
患者与方法
对因直肠癌接受直肠前切除术和DI的患者进行回顾性分析。
结果
在100例因直肠癌接受直肠前切除术并进行DI的患者中，28例（28%）发生了OO。在单因素分析中，吻合口漏和术前计算机断层扫描显示腹直肌厚度≥10 mm与OO风险显著相关。多因素分析还表明，吻合口漏（比值比 = 4.320，95%置信区间 = 1.280 - 14.60，p = 0.019）和腹直肌厚度≥10 mm（比值比 = 3.710，95%置信区间 = 1.280 - 10.70，p = 0.016）是OO的显著危险因素。
结论
当观察到OO时，应怀疑存在吻合口漏，尤其是在腹直肌厚度较高的情况下。
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