直肠癌保留括约肌术后预防性回肠造口回纳术后并发症的危险因素分析

Risk Factors of Complications Associated with Reversal of Defunctioning Ileostomy in Patients with Rectal Cancer Undergoing Sphincter Preservation Surgery

目的 分析直肠癌保留括约肌手术后行预防性回肠造口回纳术后相关并发症的危险因素。方法采用回顾性分析的方法,纳入2014年1月1日至2014年12月31日期间在我院行预防性回肠造口回纳术的直肠癌患者。结果 根据纳入和排除标准,本研究最终纳入符合入组条件的行预防性回肠造口回纳术的直肠癌患者130例,回肠造口回纳的间隔时间为39～692 d,中位时间为132 d。有35例患者术后发生并发症,包括腹泻23例,切口感染9例,肠梗阻6例,肛周湿疹4例。经单因素分析结果提示,肿瘤距肛缘距离〈5 cm（P=0.010）、术后行辅助化疗（P=0.002）及回肠造口回纳的间隔时间长（P=0.025）与预防性回肠造口回纳术后并发症的发生有关;进一步行多因素回归分析结果提示,回肠造口回纳的间隔时间（OR=1.006,P=0.021）是预防性回肠造口回纳术后并发症发生的独立危险因素。结论 直肠癌保留括约肌手术后行预防性回肠造口的延迟回纳可能会增加术后并发症的发生。

Objective To analyze risk factors of postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery. Method Data were collected retrospectively for consecutive patients undergoing defunctioning ileostomy following sphincter preservation surgery for rectal cancer, from January 2014 to December 2014. Results One hundred and thirty patients were included （median time to reversal 132 d, range 39-692 d）, of whom 35 patients （26.92%） had postoperative complications after stoma reversal. The main complications included 23 cases of diarrhea, 6 cases of bowel obstruction, 9 cases of incision infection, and 4 cases of perianal eczema. The results of univariate analysis showed that the distant of tumor from anal verge 〈5 cm （P=0.010）, postoperative adjuvant chemotherapy （P=0.002）, and time to reversal （P=0.025） were related to the postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery. The result of multivariate analysis by using a logistic regression modal showed that the time to reversal （OR=1.006, P=0.021） was a significant independent risk factor for it. Conclusion Delay reversal of defunctiong ileostomy might increase risk of postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery.