A randomised study of colostomies in low colorectal anastomoses.

A randomised study of colostomies in low colorectal anastomoses.
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低位结直肠吻合术中结肠造口术的随机研究。

DOI：
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发表时间：
1997
期刊：
The European journal of surgery = Acta chirurgica
影响因子：
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通讯作者：
H. Järvinen
H. Järvinen
中科院分区：
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文献类型：
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作者：
Pakkastie Te;J. Ovaska;Pekkala Es;Luukkonen Pe;H. Järvinen

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目的 目的探讨直肠癌低位前切除术后覆盖式造口的应用价值。 设计 前瞻性随机研究。 设置 芬兰两所大学医院。 科目 38例具有气密性吻合器端对端吻合和完整吻合组织环的患者被随机分配接受覆盖性结肠造口术（n = 19）或不接受覆盖性结肠造口术。 主要观察指标 术后死亡率、吻合口漏、因吻合口漏再次手术。 结果 临床泄漏率为24%（9/38），6例患者（16%）发生放射学泄漏。两组的泄漏总数（临床和放射学检查）相似，分别为7/19和8/19。结肠造口术组的临床渗漏较少（3/19; 16%与6/19; 32%），但差异不显著。在没有进行覆盖性结肠造口术的患者中，更经常需要因泄漏而再次手术（6/19; 32%与1/19; 5%，p = 0.09）。两名没有造口的患者死于泄漏的感染并发症，一名结肠造口组死于心力衰竭。一名最初没有接受造口的患者在泄漏后留下了永久性结肠造口术。 结论 我们的研究结果表明，覆盖性结肠造口术并不能降低低位前切除术后的漏率，但可以预防大部分严重的漏感染后果。
OBJECTIVE To assess the value of covering colostomy for patients undergoing low anterior resection for rectal neoplasms. DESIGN Prospective randomised study. SETTING Two university hospitals, Finland. SUBJECTS 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. MAIN OUTCOME MEASURES Postoperative mortality, anastomotic leaks, reoperations for leaks. RESULTS 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. CONCLUSIONS 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.