Yang Yi-Wen, Huang Sheng-Chieh, Cheng Hou-Hsuan, Chang Shih-Ching, Jiang Jeng-Kai, Wang Huann-Sheng, Lin Chun-Chi, Lin Hung-Hsin, Lan Yuan-Tzu
Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Ann Coloproctol. 2024 Dec;40(6):580-587. doi: 10.3393/ac.2022.00710.0101. Epub 2023 Jan 27.
Protective ileostomy and colostomy are performed in patients undergoing low anterior resection with a high leakage risk. We aimed to compare surgical, medical, and daily care complications between these 2 ostomies in order to make individual choice.
Patients who underwent low anterior resection for rectal tumors with protective stomas between January 2011 and September 2018 were enrolled. Stoma-related complications were prospectively recorded by wound, ostomy, and continence nurses. The cancer stage and treatment data were obtained from the Taiwan Cancer Database of our Big Data Center. Other demographic data were collected retrospectively from medical notes. The complications after stoma creation and after the stoma reversal were compared.
There were 176 patients with protective colostomy and 234 with protective ileostomy. Protective ileostomy had higher proportions of high output from the stoma for 2 consecutive days than protective colostomy (11.1% vs. 0%, P<0.001). Protective colostomy resulted in more stoma retraction than protective ileostomy (21.6% vs. 9.4%, P=0.001). Female, open operation, ileostomy, and carrying stoma more than 4 months were also significantly associated with a higher risk of stoma-related complications during diversion. For stoma retraction, the multivariate analysis revealed that female (odds ratio [OR], 4.00; 95% confidence interval [CI], 2.13-7.69; P<0.001) and long diversion duration (≥4 months; OR, 2.33; 95% CI, 1.22-4.43; P=0.010) were independent risk factors, but ileostomy was an independent favorable factor (OR, 0.40; 95% CI, 0.22-0.72; P=0.003). The incidence of complication after stoma reversal did not differ between colostomy group and ileostomy group (24.3% vs. 20.9%, P=0.542).
We suggest avoiding colostomy in patients who are female and potential prolonged diversion when stoma retraction is a concern. Otherwise, ileostomy should be avoided for patients with impaired renal function. Wise selection and flexibility are more important than using one type of stoma routinely.
对于低位前切除术渗漏风险高的患者实施保护性回肠造口术和结肠造口术。我们旨在比较这两种造口术在手术、医疗和日常护理方面的并发症，以便做出个体化选择。
纳入2011年1月至2018年9月期间因直肠肿瘤接受低位前切除术并带有保护性造口的患者。伤口、造口和失禁护理护士前瞻性记录造口相关并发症。癌症分期和治疗数据来自我们大数据中心的台湾癌症数据库。其他人口统计学数据从病历中回顾性收集。比较造口形成后和造口回纳后的并发症。
有176例患者行保护性结肠造口术，234例患者行保护性回肠造口术。保护性回肠造口术连续2天造口高排出量的比例高于保护性结肠造口术（11.1%对0%，P<0.001）。保护性结肠造口术导致的造口回缩比保护性回肠造口术更多（21.6%对9.4%，P=0.001）。女性、开放手术、回肠造口术以及造口携带时间超过4个月也与分流期间造口相关并发症的较高风险显著相关。对于造口回缩，多因素分析显示女性（比值比[OR]，4.00；95%置信区间[CI]，2.13 - 7.69；P<0.001）和较长的分流持续时间（≥4个月；OR，2.33；95%CI，1.22 - 4.43；P=0.010）是独立危险因素，但回肠造口术是独立的有利因素（OR，0.40；95%CI，0.22 - 0.72；P=0.003）。结肠造口术组和回肠造口术组造口回纳后的并发症发生率无差异（24.3%对20.9%，P=0.542）。
我们建议，当担心造口回缩时，对于女性患者以及可能需要长时间分流的情况应避免行结肠造口术。否则，对于肾功能受损的患者应避免行回肠造口术。明智的选择和灵活性比常规使用一种类型的造口更为重要。
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