Current use of diverting stoma in anterior resection for cancer: population-based cohort study of total and partial mesorectal excision
Current use of diverting stoma in anterior resection for cancer: population-based cohort study of total and partial mesorectal excision
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DOI：
10.1007/s00384-015-2465-6
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发表时间：
2016-03-01
影响因子：
2.8
通讯作者：
Rutegard, Jorgen
中科院分区：
文献类型：
--
作者：
Rutegard, Martin;Bostrom, Petrus;Rutegard, Jorgen
目的在直肠癌前切除术中，全直肠系膜切除术（TME）时，常采用转向造口以降低吻合口瘘的风险。本研究的目的是评估粪便改道的影响，部分直肠系膜切除术（PME）。方法进行了回顾性分析，对一个国家的队列，最初创建的研究中心动脉结扎对患者的心血管风险增加的影响。对2007年至2010年间741例直肠癌前切除术患者进行了53个月的随访。采用多因素Logistic回归分析，以比值比（OR）和95%可信区间（CI）为指标，评价吻合口转流对TME术后吻合口瘘和永久性吻合口的影响（OR 5.1; 95% CI 2.2-11.6），而PME患者的相应风险增加是适度的（OR 1.8; 95% CI 0.8-4.0）。在研究完成或死亡时，分别有26%和13%的TME和PME患者有永久性造口。在PME患者中，造口转向是永久性造口的危险因素（OR 4.7; 95%CI 2.5-9.0），而在TME患者中，造口转向的危险性较小（OR 1.8; 95%CI 0.6-5.5）。此外，分流造口本身可能有助于永久性造口的高比率。
Purpose A diverting stoma is commonly used to reduce the risk of anastomotic leakage when performing total mesorectal excision (TME) in anterior resection for rectal cancer. The purpose of this study was to evaluate the impact of fecal diversion in relation to partial mesorectal excision (PME).Methods A retrospective analysis was undertaken on a national cohort, originally created to study the impact of central arterial ligation on patients with increased cardiovascular risk. Some 741 patients operated with anterior resection for rectal cancer during the years 2007 through 2010 were followed up for 53 months. Multivariate logistic regression was used to evaluate the impact of diverting stoma on the risk of anastomotic leakage and permanent stoma, expressed as odds ratios (ORs) and 95 % confidence intervals (CIs).Results The risk of anastomotic leakage was increased in TME surgery when not using a diverting stoma (OR 5.1; 95 % CI 2.2-11.6), while the corresponding risk increase in PME patients was modest (OR 1.8; 95 % CI 0.8-4.0). At study completion or death, 26 and 13 % of TME and PME patients, respectively, had a permanent stoma. A diverting stoma was a statistically significant risk factor for a permanent stoma in PME patients (OR 4.7; 95 % CI 2.5-9.0), while less important in TME patients (OR 1.8; 95 % CI 0.6-5.5).Conclusion The benefit of a diverting stoma concerning anastomotic leakage in this patient group seems doubtful. Moreover, the diverting stoma itself may contribute to the high rate of permanent stomas.