Antegrade Enema After Total Mesorectal Excision for Rectal Cancer: The Last Chance to Avoid Definitive Colostomy for Refractory Low Anterior Resection Syndrome and Fecal Incontinence
Antegrade Enema After Total Mesorectal Excision for Rectal Cancer: The Last Chance to Avoid Definitive Colostomy for Refractory Low Anterior Resection Syndrome and Fecal Incontinence
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DOI：
10.1097/dcr.0000000000001089
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发表时间：
2018-06-01
影响因子：
3.9
通讯作者：
Rullier, Eric
中科院分区：
文献类型：
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作者：
Didailler, Romain;Denost, Quentin;Rullier, Eric
背景：全直肠系膜切除和术前放疗治疗中低位直肠癌可以取得很好的肿瘤学效果。目的：我们评估了难治性低位直肠切除综合征和全直肠系膜切除术后大便失禁患者顺行灌肠治疗的功能结果。设计：这是一项2012至2016年间的前瞻性单中心研究。患者：接受经皮内窥镜下盲肠造瘘术治疗难治性低位直肠切除综合征和全直肠系膜切除术后大便失禁。主要结果指标：我们评估了该手术的发病率，并比较了低位直肠切除综合征评分、Wexner评分、低前切除综合征评分、Wexner评分、低前切除术综合征评分、Wexner评分、低前切除术综合征评分、Wexner评分、低前切除综合征评分、低前切除综合征评分、Wexner评分、低前切除综合征评分、Wexner评分、低前切除综合征评分、低前切除综合征评分、Wexner评分、低位直肠系膜切除术后大便失禁。结果：在研究期间接受顺行灌肠治疗的25例患者中，6例(24%)行低位前切除，18例(72%)行结直肠吻合术，1例(4%)行会阴结肠造口术。术后局部脓肿发生率为8%，均采用抗生素治疗。术后低位前切除综合征评分(33vs4，p<；0.001)、韦克斯纳评分(16vs4，p<；0.001)和胃肠道生活质量指数(73vs104，p<；0.001)均有明显改善。患者报告的两个主要症状是出汗(28%)和局部疼痛(36%)。在随访结束时，16%(n=4)的导尿管被拔除，最终造口率为12%(n=3)。限制：本研究的主要局限性是单中心特征和样本大小。结论：顺行灌肠治疗主要和难治性低位前切除综合征和全直肠系膜切除术后大便失禁似乎是一种很有前途的治疗方法，可以避免最终造口。请参阅http://links.lww.com/DCR/A608.上的视频摘要
BACKGROUND: Total mesorectal excision and preoperative radiotherapy in mid and low rectal cancer allow us to achieve very good oncological results. However, major and refractory low anterior resection syndrome and fecal incontinence alter the quality of life of patients with a long expected life span.OBJECTIVE: We assessed the functional results of patients treated by antegrade enema for refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision.DESIGN: This is a prospective monocentric study from 2012 to 2016.PATIENTS: Patients who underwent percutaneous endoscopic cecostomy for refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision were prospectively analyzed.MAIN OUTCOME MEASURES: We assessed the morbidity of the procedure and compared low anterior resection syndrome score, Wexner score, and Gastrointestinal Quality of Life Index before and after the use of antegrade enema.RESULTS: Of 25 patients treated by antegrade enema over the study period, 6 (24%) had a low anterior resection, 18 (72%) had a coloanal anastomosis, and 1 (4%) had a perineal colostomy. Postoperatively, the rate of local abscess was 8%, all treated by antibiotics. Low anterior resection syndrome score (33 vs 4, p < 0.001), Wexner score (16 vs 4, p < 0.001), and Gastrointestinal Quality of Life Index (73 vs 104, p < 0.001) were all significantly improved after antegrade enema. The 2 main symptoms reported by patients were sweating (28%) and local pain (36%). At the end of the follow-up, 16% (n = 4) catheters were removed, and the rate of definitive colostomy was 12% (n = 3).LIMITATIONS: The main limitations of this study are the monocentric features and the sample size.CONCLUSION: Antegrade enema for major and refractory low anterior resection syndrome and fecal incontinence after total mesorectal excision appears to be a promising treatment to avoid definitive colostomy. See Video Abstract at http://links.lww.com/DCR/A608.