影响中低位直肠癌术后预防性肠造口回纳相关因素的研究

Analysis of factors related to permanent stoma after sphincter preserving low anterior resection ofmiddle and low rectal cancer

目的探讨中低位直肠癌术后预防性肠造口不能回纳的危险因素。 方法分析我院315例中低位直肠癌住院病例。χ2检验分析造口类型与临床病理变量之间的关系。用Kaplan-Meier生存曲线分析永久性造口的预测因素。用Cox比例风险回归法对危险因素进行评估。 结果在315例患者中，127例行预防性造口，其中116例行末端回肠袢式造口，11例行结肠造口。其中94例回肠造口术后予回纳，造口到回纳间隔时间的中位值为6.3个月；3例造口关闭后重新造口，25例患者回肠预防性造口成为永久性造口。随访2年，回肠造口不可回纳的累计发生率为14%。单因素分析显示，浸润深度、淋巴结转移、远处转移、括约肌间切除、吻合口手工缝合和术前放化疗与永久性造口相关，而多因素分析显示远处转移、浸润深度、术前放化疗是预防性肠造口不能回纳的危险因素。 结论直肠癌远处转移或局部复发是影响造口回纳的最重要因素，而肿瘤距肛门缘的距离、淋巴结转移的数量、吻合的方式均对造口回纳影响较小。

ObjectiveTo identify the risk factors for permanent stoma following low anterior resection with a temporary ileostomy for rectal cancer. MethodsA total of 315 consecutive rectal cancer patients were retrospectively reviewed. The associations between the type of stoma and clinicopathological variables were analyzed using chi-square tests. The predictive factors for permanent stoma were analyzed using the Kaplan-Meier survival curve. Multivariate analyses were also performed by the Cox proportional hazards model. ResultsAmong 315 patients, 127 cases underwent temporary stoma, and diverting ileostomy and colostomy were performed on 116 and 11 patients respectively. Among the ileostomy cases, 94 underwent stoma reversal, and the median interval from initial surgery to stoma closure was 6.3 months. Three patients eventually underwent stoma recreation, and hence, 25 patients had permanent stoma. The stoma non-reversal rate was 14% at 2nd year after surgery. Lymph node metastasis, intersphincteric resection and hand sewn anastomosis were associated with permanent stoma on univariate analysis, but not on multivariate analysis. Based on the findings of multivariate, distant metastasis, depth of invasion and preoperative chemoradiotherapy were the risk factors of preventing stoma closure. ConclusionThe most common factors preventing stoma closure included distant metastasis and local recurrence. However, distance from anal verge, the number of lymph node metastasis and type of resection had little effect on the stoma closure.