Anastomotic Sinus That Developed From Leakage After a Rectal Cancer Resection: Should We Wait for Closure of the Stoma Until the Complete Resolution of the Sinus?
Anastomotic Sinus That Developed From Leakage After a Rectal Cancer Resection: Should We Wait for Closure of the Stoma Until the Complete Resolution of the Sinus?
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DOI：
10.3393/ac.2018.08.13
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发表时间：
2019-01
影响因子：
3.1
通讯作者：
C. Chung;S. Baek;J. Kwak;Jin Kim;Seon-Han Kim
中科院分区：
文献类型：
--
作者：
C. Chung;S. Baek;J. Kwak;Jin Kim;Seon-Han Kim
目的 本研究的目的是确定吻合口窦的临床特征，并评估延迟患者造口闭合直至吻合口窦完全消退的有效性。方法 研究对象为2011年至2017年接受直肠癌切除术、保护性或治疗性回肠改道造口术、因吻合口瘘后遗症而出现窦道的患者。测量的主要结果是吻合窦的发生率、治疗和结果。结果 876例接受低位前切除术的患者中，14例（1.6%）在回肠造口关闭前经乙状结肠镜检查或泛影葡胺灌肠发现吻合口窦。 14例鼻窦患者中，7例按期接受回肠造口闭合，平均闭合时间4.1个月。其余7例患者接受了回肠造口修复术，但延迟至随访时采用指状扩张术扩大窦口后，平均闭合时间为6.9个月。剩下的七名患者中，有四名患者接受了造口闭合术，尽管他们的鼻窦状况尚未完全解决。 14 名吻合口窦患者闭合后均未出现盆腔脓毒症并发症，但 14 名患者中有 2 名因严重吻合口狭窄而需要重新改道。结论 经过精心挑选的吻合口患者，及时成功封堵回肠造口。
Purpose The aims of this study were to identify the clinical characteristics of an anastomotic sinus and to assess the validity of delaying stoma closure in patients until the complete resolution of an anastomotic sinus. Methods The subject patients are those who had undergone a resection of rectal cancer from 2011 to 2017, who had a diversion ileostomy protectively or therapeutically and who developed a sinus as a sequelae of anastomotic leakage. The primary outcomes that were measured were the incidence, management and outcomes of an anastomotic sinus. Results Of the 876 patients who had undergone a low anterior resection, 14 (1.6%) were found to have had an anastomotic sinus on sigmoidoscopy or a gastrografin enema before their ileostomy closure. In the 14 patients with a sinus, 7 underwent ileostomy closure as scheduled, with a mean closure time of 4.1 months. The remaining 7 patients underwent ileostomy repair, but it was delayed until after the follow-up for the widening of the sinus opening by using digital dilation, with a mean closure time of 6.9 months. Four of those remaining seven patients underwent stoma closure even though their sinus condition had not yet been completely resolved. No pelvic septic complications occurred after closure in any of the 14 patients with an anastomotic sinus, but 2 of the 14 needed a rediversion due to a severe anastomotic stricture. Conclusion Patients with an anastomotic sinus who had been carefully selected underwent successful ileostomy closure without delay.