摘要
背景 建立临时性回肠造口被认为是预防直肠癌术后严重吻合口漏的有效方法.然而,对接受辅助化疗的患者施行回肠造口还纳术的最佳时机尚不清楚.本研究旨在探讨在辅助化疗期间进行早期回肠造口还纳的安全性和远期效果.方法 回顾性评价2017年4月至2021年4月接受腹腔镜直肠癌手术联合临时性回肠造口术且接受辅助化疗的患者的临床结局.患者被分为在辅助化疗期间还纳回肠造口的早期还纳组(A组)和在辅助化疗结束之后还纳回肠造口的晚期还纳组(B组).结果 本研究共纳入215例患者,其中A组115例、B组100例.两组在人口统计学和临床特征方面无明显差异.与B组相比,A组携带造口时间(P＜0.001)和低位前切除综合征症状持续时间(P＜0.001)较短;直肠狭窄(P=0.036)和造口相关并发症(P=0.007)较少,尤其是造口狭窄(P=0.041).然而,A组患者接受化疗的治疗依从性较差(P=0.009).两组手术时间(P=0.442)、术后住院时间(P=0.558)、术后并发症发生率(P=0.102)、低位前切除综合征的发生情况/严重程度(P=0.690)、无进展生存期(P=0.612)、总生存期(P=0.585)比较差异无统计学意义.结论 早期还纳回肠造口可以有效缩短携带造口时间和低位前切除综合征症状持续时间,降低直肠狭窄和造口相关并发症的发生率,同时不影响手术并发症的发生情况和肿瘤学结局.因此,回肠造口还纳术不应因辅助化疗而延迟施行.需要指出的是,应加强随访管理以提高患者接受化疗的治疗依从性和完整性.
Abstract
Background Protective ileostomy can effectively prevent severe anastomotic leakage after rectal cancer sur-gery;however,the optimal timing for ileostomy closure during adjuvant chemotherapy remains unclear.This study aimed to explore the safety and long-term outcomes of early ileostomy closure during adjuvant chemotherapy.Method Patients who underwent laparoscopic rectal cancer surgery combined with protective ileostomy and adjuvant chemotherapy be-tween April 2017 and April 2021 were retrospectively evaluated.Patients were divided into an early closure group dur-ing chemotherapy(group A)and a late closure group after chemotherapy(group B).Results A total of 215 patients were included in this study,with 115 in group A and 100 in group B.There were no significant differences in demo-graphic and clinical characteristics between the two groups.In group A,durations of stoma status(P＜0.001)and low anterior resection syndrome(LARS)(P＜0.001)were shorter,and rectal stenosis(P=0.036)and stoma-related complica-tions(P=0.007),especially stoma stenosis(P=0.041),were less common.However,compliance with chemotherapy was worse(P=0.009).There were no significant differences in operative time,postoperative hospital stay,postoperative com-plications,incidence and severity of LARS,disease-free survival,or overall survival between groups.Conclusion Early il-eostomy closure can effectively reduce the duration of stoma status,duration of LARS,rectal stenosis,and stoma-related complications while not affecting surgical complications and oncological outcomes.Ileostomy closure should not be de-layed because of adjuvant chemotherapy.However,follow-up should be strengthened to increase compliance and integrity with chemotherapy.
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