Pakkastie T E, Ovaska J T, Pekkala E S, Luukkonen P E, Järvinen H J
Second Department of Surgery, Helsinki University Central Hospital, Finland.
Eur J Surg. 1997 Dec;163(12):929-33.
To assess the value of covering colostomy for patients undergoing low anterior resection for rectal neoplasms.
Prospective randomised study.
Two university hospitals, Finland.
38 patients with air-tight stapled end-to-end anastomoses and complete anastomotic tissue rings were randomly allocated to have a covering colostomy (n = 19) or not.
Postoperative mortality, anastomotic leaks, reoperations for leaks.
The clinical leak rate was 24% (9/38) and six patients (16%) had radiological leaks. The total number of leaks (clinical and radiological together) was similar in the two groups, 7/19 compared with 8/19, respectively. There were fewer clinical leaks in the colostomy group (3/19; 16% compared with 6/19; 32%), but the difference was not significant. Reoperations for leaks were necessary more often in patients who did not have a covering colostomy (6/19; 32% compared with 1/19; 5%, p = 0.09). Two patients who did not have a stoma died from the infective complications of their leaks and one died of heart failure in the colostomy group. One patient who had not been given a stoma initially was left with a permanent colostomy after a leak.
Our results suggest that a covering colostomy does not reduce the leak rate after low anterior resection, but prevents most of the severe infective consequences of the leaks.
评估结肠造口术对直肠肿瘤行低位前切除术患者的价值。
前瞻性随机研究。
芬兰的两家大学医院。
38例采用气密吻合器进行端端吻合且有完整吻合组织环的患者被随机分为两组，一组行结肠造口术（n = 19），另一组不行结肠造口术。
术后死亡率、吻合口漏、因漏进行的再次手术。
临床漏率为24%（9/38），6例患者（16%）有影像学证实的漏。两组漏的总数（临床漏和影像学漏合计）相似，分别为7/19和8/19。结肠造口术组的临床漏较少（3/19；16%，而未行结肠造口术组为6/19；32%），但差异无统计学意义。未行结肠造口术的患者因漏进行再次手术的频率更高（6/19；32%，而结肠造口术组为1/19；5%，p = 0.09）。未行造口术的两名患者死于漏的感染性并发症，结肠造口术组有一名患者死于心力衰竭。一名最初未行造口术的患者在发生漏后留置了永久性结肠造口。
我们的结果表明，结肠造口术并不能降低低位前切除术后的漏率，但可预防漏导致的大多数严重感染后果。
