直肠癌术后预防性回肠造口早期还纳的研究进展

Recent progress in early closure of protective ileostomy after rectal cancer surgery

直肠癌术后预防性回肠造口的还纳时机尚未统一, 目前多采用3个月左右进行还纳。随着加速康复外科理念在临床患者中的应用和治疗技术的不断进步, 早期还纳回肠造口(EIC)的有效性和安全性成为目前研究的热点。越来越多的直肠癌患者开始接受新辅助放化疗, 这也给还纳时机带来了不确定性。预防性回肠造口不仅带来了造口相关并发症, 也给患者带来极大的心理负担, 部分患者对EIC有迫切需求, 但目前EIC的最佳时机以及哪些患者需要EIC缺乏共识。本文就早期还纳的优势、争议、最佳时机探索、放化疗对早期还纳的影响、早期还纳的适应证和禁忌证等方面的研究现状进行综述, 为临床医师早期回肠造口还纳提供参考。

The timing for closure of prophylactic ileostomy after rectal cancer surgery is not unified,and it is generally recommended to return the stoma after 3 months.With the application of enhanced recovery after surgery in clinical patients and the continuous progress of technology,the effectiveness and safety of early ileostomy closure(EIC)are the focus of current researches.More and more patients with rectal cancer begin to receive neoadjuvant chemoradiotherapy,which also brings uncertainty to the time of ileostomy closure.prophylactic ileostomy not only brings about stoma-related complications,but also brings great psychological burden to patients.Some patients have an urgent need for EIC,but there is no consensus on the optimal timing for EIC and which patients need EIC.This article reviews the advantages,controversies,optimal timing,the influence of chemoradiotherapy,the indications and contraindications of early closure and provide reference for clinicians.