Aida Takashi, Kamada Teppei, Takahashi Junji, Nakashima Keigo, Ito Eisaku, Suzuki Norihiko, Hata Taigo, Yoshida Masashi, Ohdaira Hironori, Suzuki Yutaka
Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara, Japan.
J Anus Rectum Colon. 2024 Apr 25;8(2):78-83. doi: 10.23922/jarc.2023-048. eCollection 2024.
Parastomal hernia (PSH) is a common complication of colostomy; however, its risk factors remain poorly investigated. In this study, we examined the associations between sarcopenia, visceral and subcutaneous fat, and PSH in patients who underwent transperitoneal colostomy for colorectal cancer.
This retrospective, single-center, cohort study included 60 patients who underwent laparoscopic or robot-assisted abdominoperineal resection or Hartmann's procedure for colorectal cancer between November 2010 and February 2022. Stoma creation was uniformly performed using the transperitoneal approach, and PSH was diagnosed via abdominal computed tomography (CT) at 1 year postoperatively. Visceral fat areas (VFAs) and subcutaneous fat areas (SFAs) were measured through preoperative CT images using an image analysis system. Risk factors for PSH were retrospectively analyzed.
PSH was diagnosed in 13 (21.7%) patients. In the univariate analysis, PSH was significantly associated with body mass index >22.3 kg/m (=0.002), operation time >319 min (=0.027), estimated blood loss >230 mL (=0.008), postoperative complications (=0.028), stoma diameter >18.6 mm (=0.015), VFA >89.2 cm (=0.005), and SFA >173.2 cm (=0.001). Multivariate analyses confirmed that SFA >173.2 cm (odds ratio: 16.7, 95% confidence interval 1.29-217.2, =0.031) was an independent risk factor for PSH.
Subcutaneous fat area is significantly associated with the development of PSH after transperitoneal colostomy. Applying these insights could help to prevent PSH.
造口旁疝（PSH）是结肠造口术的常见并发症；然而，其危险因素仍未得到充分研究。在本研究中，我们调查了接受结直肠癌经腹结肠造口术患者的肌肉减少症、内脏脂肪和皮下脂肪与PSH之间的关联。
这项回顾性、单中心队列研究纳入了2010年11月至2022年2月间因结直肠癌接受腹腔镜或机器人辅助腹会阴切除术或哈特曼手术的60例患者。均采用经腹途径进行造口，术后1年通过腹部计算机断层扫描（CT）诊断PSH。使用图像分析系统通过术前CT图像测量内脏脂肪面积（VFA）和皮下脂肪面积（SFA）。对PSH的危险因素进行回顾性分析。
13例（21.7%）患者被诊断为PSH。在单因素分析中，PSH与体重指数>22.3kg/m²（P=0.002）、手术时间>319分钟（P=0.027）、估计失血量>230mL（P=0.008）、术后并发症（P=0.028）、造口直径>18.6mm（P=0.015）、VFA>89.2cm²（P=0.005）和SFA>173.2cm²（P=*0.001）显著相关。多因素分析证实，SFA>173.2cm²（比值比：16.7，95%置信区间1.29-217.2，P=0.031）是PSH的独立危险因素。
皮下脂肪面积与经腹结肠造口术后PSH的发生显著相关。应用这些见解可能有助于预防PSH。
