Segreti E M, Levenback C, Morris M, Lucas K R, Gershenson D M, Burke T W
Department of Gynecologic Oncology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Gynecol Oncol. 1996 Jan;60(1):49-53. doi: 10.1006/gyno.1996.0010.
The purpose of this study was to evaluate the early morbidity, stomal complications, and overall survival rate of gynecologic oncology patients treated with end or loop colostomy for management of colonic fistula.
Seventy-five women with fistulas undergoing fecal diversion procedures from 1983 to 1993 were identified. Information relevant to tumor history, type of fistula, operative procedure, complications, and outcome was extracted from the medical records.
A recto- or sigmoid-vaginal fistula was present in 55 patients. The remaining 20 patients had either a colonic fistula involving the bladder, uterus, or skin or multiple fistulas. In 66 (88%) patients, the pelvis had been irradiated. Loop colostomy was performed in 47 (63%) patients and end colostomy in 28 (37%) of patients. Cancer was present in 31 (66%) of 47 patients undergoing loop colostomy compared with 12 (43%) of 28 patients undergoing end colostomy (P = 0.05). No significant differences were detected with regard to age at cancer diagnosis or age at the time of colostomy, body habitus, medical condition, type of cancer, history of pelvic irradiation, or incidence of multiple or complex fistulas. Median operative time was increased by 1 hr and median blood loss from 50 to 200 ml with end colostomy. No significant advantage of loop colostomy over end colostomy was detected in the incidence of acute morbidity or hospital stay. Early stomal complications occurred in 8 patients, 7 of whom had loop colostomy (P = 0.25). Delayed complications (prolapse, retraction, stool per vagina, or fistula) following loop colostomies occurred more frequently than following end colostomy: 12 (26%) of 47 compared with 2 (7%) of 28 (P = 0.05), respectively. Five loop stomas were later converted to end stomas. In addition only one of four attempted loop colostomy closures was successful. Overall survival in both groups of patients was similar.
There were no statistically significant differences between patients treated with loop or end colostomy with regard to early morbidity or survival. The early and frequent occurrences of stomal complications after loop colostomy overshadow the clinically minor advantages of this method of fecal diversion. Although loop colostomy was performed more often in this setting, these data do not support its routine use for the management of gynecologic oncology patients with fistulas.
本研究旨在评估因结肠瘘接受端式或袢式结肠造口术治疗的妇科肿瘤患者的早期发病率、造口并发症及总生存率。
确定了1983年至1993年间75例因瘘管接受粪便转流手术的女性。从病历中提取与肿瘤病史、瘘管类型、手术操作、并发症及结局相关的信息。
55例患者存在直肠或乙状结肠阴道瘘。其余20例患者有累及膀胱、子宫或皮肤的结肠瘘或多发瘘。66例（88%）患者曾接受盆腔放疗。47例（63%）患者行袢式结肠造口术，28例（37%）患者行端式结肠造口术。47例行袢式结肠造口术的患者中有31例（66%）患有癌症，而行端式结肠造口术的28例患者中有12例（43%）患有癌症（P = 0.05）。在癌症诊断年龄或结肠造口时的年龄、身体状况、健康状况、癌症类型、盆腔放疗史或多发或复杂瘘的发生率方面未检测到显著差异。端式结肠造口术的中位手术时间增加1小时，中位失血量从50毫升增至200毫升。在急性发病率或住院时间方面，未检测到袢式结肠造口术比端式结肠造口术有显著优势。8例患者发生早期造口并发症，其中7例为袢式结肠造口术（P = 0.25）。袢式结肠造口术后的延迟并发症（脱垂、回缩、经阴道排便或瘘）比端式结肠造口术更常见：47例中有12例（26%），而28例中有2例（7%）（P = 0.05）。5个袢式造口后来改为端式造口。此外，4例尝试关闭袢式结肠造口术的患者中只有1例成功。两组患者的总生存率相似。
在早期发病率或生存率方面，接受袢式或端式结肠造口术治疗的患者之间无统计学显著差异。袢式结肠造口术后早期和频繁发生的造口并发症掩盖了这种粪便转流方法在临床上的微小优势。尽管在这种情况下袢式结肠造口术施行得更频繁，但这些数据不支持将其常规用于治疗患有瘘管的妇科肿瘤患者。
