Friedmann P, Garb J L, McCabe D P, Chabot J R, Park W C, Stark A, Coe N P, Page D W
Surg Gynecol Obstet. 1987 Mar;164(3):257-60.
A retrospective review was conducted on 133 patients who underwent anterior resection and primary intestinal anastomosis for adenocarcinoma of the rectum from 1973 to 1983 at the Baystate Medical Center. Forty patients received a moderate dose, 4,500 rads, of radiation therapy preoperatively. Twenty-six of these patients (65 per cent) underwent protective colostomy at operation. An additional 93 patients underwent an operation without radiation and 38 of these (42 per cent) had a colostomy. We found no significant difference between patients who did or did not undergo radiation therapy in the over-all rate of complications (25 per cent for those who underwent radiation and 29 per cent for those who did not). Furthermore, there was no significant difference in anastomotic leak rates between the two groups (10 and 7 per cent respectively), even after controlling for the presence of a protective colostomy. We did find that leak rates for both groups were markedly higher for patients with a colostomy (14 per cent) than for patients without (1 per cent) (p less than 0.005). We conclude that a moderate dose of radiation therapy preoperatively does not increase the risk of anastomotic leakage or other operative complications with anterior resection. Colorectal intestinal anastomosis may be safely performed without routine colostomy after planned preoperative adjuvant radiation therapy if the anastomosis is technically satisfactory.
对1973年至1983年期间在贝斯州医疗中心因直肠癌接受前切除术和原发性肠吻合术的133例患者进行了回顾性研究。40例患者术前接受了中等剂量（4500拉德）的放射治疗。其中26例患者（65%）在手术时进行了保护性结肠造口术。另外93例患者未接受放疗直接进行了手术，其中38例（42%）进行了结肠造口术。我们发现，接受放疗和未接受放疗的患者在总体并发症发生率方面没有显著差异（接受放疗的患者为25%，未接受放疗的患者为29%）。此外，即使在考虑了保护性结肠造口术的因素后，两组之间的吻合口漏发生率也没有显著差异（分别为10%和7%）。我们确实发现，有结肠造口术的患者两组的漏发生率（14%）均明显高于没有结肠造口术的患者（1%）（P<0.005）。我们得出结论，术前中等剂量的放射治疗不会增加前切除术吻合口漏或其他手术并发症的风险。如果吻合技术满意，在计划的术前辅助放疗后，可安全地进行结直肠肠吻合术而无需常规结肠造口术。
