Defunctioning Stoma in Locally Advanced Rectal Cancer Receiving Concurrent Chemoradiotherapy and Low Anterior Resection

暫時性腸造口在局部廣泛性直腸癌患者接受術前化學放射協同治療後行低前位切除術中所扮演之角色

鄞子傑(Tzu-Chieh Yin) ； 高理鈞(Li-Chun Kao) ； 楊濱輔(Ping-Fu Yang) ； 馬政仁(Cheng-Jen Ma) ； 黃敬文(Ching-Wen Huang) ； 陳芳銘(Fang-Ming Chen) ； 莊捷翰(Chieh-Han Chuang) ； 陳漢文(Hon-Man Chan) ； 黃哲人(Che-Jen Huang) ； 謝建勳(Jan-Sing Hsieh) ； 王照元(Jaw-Yuan Wang)

《中華民國大腸直腸外科醫學會雜誌》 25卷1期 (2014/03) Pp. 8-15

https://doi.org/10.6312/SCRSTW.2014.25(1).10217

摘要

目的　暫時性腸造口對低位直腸癌手術而言可以減少吻合處滲漏與再度手術之機率。術前放射性治療或同步化學放射治療則增加了局部廣泛性直腸癌施行括約肌保留手術之可能性。本篇文章在釐清暫時性腸造口在接受過化學放射協同治療後施行根治性直腸切除手術中所扮演的角色。方法　從2010年7月至2012年10月，我們回朔分析83個曾接受術前同步化學放射治療之局部廣泛性直腸癌患者，75人（90%）接受了根治性直腸切除手術，並且藉大腸直腸或大腸肛門吻合來重建腸道連續性。當中的43個（57%）個案同時施行了暫時性腸造口。結果　根治性直腸切除手術合併暫時性腸造口的病人有較多的術中出血情形（p = 0.0281）。但吻合處滲漏與再度手術之機率並未因暫時性腸造口而有明顯減少。如果我們把吻合高度限制在距肛門口4公分或4公分以下，那暫時性腸造口可將低前位切除術吻合處滲漏機率從21.4%降到12.5%，再度手術機率由14.3%降到3.1%。結論　雖然暫時性腸造口無法顯著地將曾接受術前化學放射協同治療之局部廣泛性直腸癌患者吻合處滲漏與再度手術之機率降低，但我們依舊可以發現，當吻合處高度在肛門口4公分或4公分以下，暫時性腸造口之重要性有提升之傾向。對於經術前化學放射協同治療後之超低位直腸癌，低前位切除術仍建議加作暫時性腸造口以保護吻合處。

關鍵字

暫時性腸造口 ； 直腸癌 ； 同步化學放射治療 ； 根治性直腸切除手術

並列摘要

Purpose. Temporary defunctioning stoma reduces the rate of anastomotic leakage and reoperation in lower-third rectal cancer surgery. Preoperative radiotherapy or concurrent chemoradiotherapy raises the probability of performing sphincter-preserving surgery in locally advanced rectal cancer. The main purpose of this study is to clarify the role of defunctioning stoma in radical proctectomy in the subgroup of patients received concurrent chemoradiotherapy.Methods. From July 2010 to November 2012, we retrospectively analyzed 83 locally advanced rectal cancer patients receiving operation following concurrent chemoradiotherapy; seventy-five (90%) of them received subsequent radical proctectomies and bowel continuity was restored primarily by either colorectal anastomosis or coloanal anastomosis. Of them, defunctioning stomas were created in 43 (57%) cases.Results. More blood loss was found in patients received radical proctectomy with temporary stoma during operation (p = 0.0281). However, the anastomotic leakage rate and re-operation rate were not significantly reduced by existence of defunctioning stoma. If we confined the anastomotic level to less than or equal to 4 cm from anal verge, defunctioning stoma reduced the anastomotic rate from 21.4% to 12.5% and reoperation rate from 14.3% to 3.1% in radical proctectomy.Conclusions. Although defunctioning stoma doesn't significantly decrease the anastomotic rate and reoperation rate in locally advanced rectal cancer patients receiving preoperative concurrent chemoradiotherapy, we can still find the trend of increasing importance when the anastomotic level is lower than or equal to 4 cm above the anal verge. For ultra-lower-third rectal cancer receiving concurrent chemoradiotherapy, anastomosis should still be protected by adding defunctioning stoma to radical proctectomy.

並列關鍵字

Defunctioning stoma ； Rectal cancer ； Concurrent chemoradiotherapy ； Radical proctectomy