- 期刊
Complications of Loop Transverse Colostomy and Loop Ileostomy Closure in Patients with Mid-to-low Rectal Cancer Undergoing Sphincter-preserving Surgery
中低位直腸癌病患接受根除性手術合併迴腸造口或結腸造口其造口關閉手術的預後
摘要
Purpose. Diverting stoma is a common additional procedure for patients undergoing curative surgery for rectal cancer to reduce the risk of symptomatic anastomotic leakage. This study aimed to compare the outcomes of loop ileostomy closure and loop transverse colostomy. Methods. This single-center, retrospective cohort study included patients who underwent curative resection for mid-to-low rectal cancer with diverting stoma and subsequent stoma reversal between January 2006 and December 2015. Detailed information was retrieved from the Colorectal Section Tumor Registry of Chang Gung Memorial Hospital. Results. Overall, 104 patients underwent loop ileostomy closure, and 524 patients underwent loop transverse colostomy closure. No significant difference in operation time was observed between the two groups (99 vs. 106; p = 0.116). Post-closure wound infections occurred more frequently in the loop transverse colostomy group than that in the ileostomy group (8.9% vs. 2.8%, p = 0.036). The incidence of anastomotic leakage was higher in the ileostomy group than in the loop transverse colostomy group (3.8 vs. 1.1; p = 0.044). The length of hospital stay was similar between the two groups (9.81 vs. 9.22; p = 0.49). Conclusions. In this study, the most common complications after stoma reversal in patients with low rectal cancer are postoperative ileus, postclosure wound infection, anastomosis leakage, and incisional hernia. More patients in the transverse colostomy group experienced post-closure wound infection than those in the ileostomy group. Closure of ileostomy was associated with higher risk of anastomotic leakage compared with closure of colostomy.
並列摘要
目的：中低位直腸癌的病患於接受根除性手術時，常同時接受暫時性腸造口手術，以減少吻合不全的症狀，這篇研究是比較迴腸造口關閉手術和結腸造口關閉手術的預後。方法：這是一篇回顧性單中心研究，包括2006年一月至2015年十二月進行根除性手術治療且接受暫時性腸造口手術及造口關閉手術的中低位直腸癌病患，研究分析取自於林口長庚醫院大腸直腸外科癌症資料庫。結果：研究收錄104位接受迴腸造口手術的病患以及524位接受結腸造口的病患，手術時間兩組無統計差異（99 vs. 106；p = 0.116），接受結腸造口關閉手術的病患有較高比率併發傷口感染比率（8.9% vs. 2.8；p = 0.036），而接受迴腸造口關閉手術的病患有較高比率併發吻合不全（3.8 vs. 1.1；p = 0.044），兩組在住院天數無達到統計上的顯著差異（9.81 vs. 9.22；p = 0.49）。結論：中低位直腸癌患者接受腸造口關閉手術常發生的併發症包括發術後腸阻塞、手術傷口感染、吻合不全、以及切口疝氣，關閉結腸造口有較高比率併發手術傷口感染，而關閉迴腸造口有較高比率併發吻合不全。