在接受術前化學放射協同治療及低前位切除術後之局部廣泛性直腸癌病患早期關閉暫時性腸造口將增加手術相關之併發症

Early closure of defunctioning stoma increases complications related to stoma closure in patients with locally advanced rectal cancer after concurrent chemoradiotherapy and radical proctectomy

鄞子傑(Tzu-Chieh Yin)

指導教授 ： 王照元

共同指導教授 ： 潘美仁(Mei-Ren Pan)

高雄醫學大學/醫學院/臨床醫學研究所/碩士(2016年)

摘要

暫時性腸造口對罹患低位直腸癌患者接受術前合併化學放射治療及廣泛性直腸切除手術後確保吻合處安全無虞至關重要。雖然減少了吻合處滲漏所造成的併發症以及再次手術的風險，但在造口關閉之前與之後相關之併發症都須謹慎評估與處置。我們從2010年6月至2012年11月總共蒐集了83位接受過術前合併化學放射治療的局部廣泛性直腸癌患者的資料，當中有43位患者在行廣泛性直腸切除同時行暫時性腸造口，另外三位則是在吻合處發生滲漏漏後行補救性造口。從造口至造口關閉這段期間內併發症總發生率為30.4%，當中迴腸造口比大腸造口更常造成患者腎功能不全並且明顯增加了再入院率。與造口關閉相關之併發症發生率則是28.1％，其中男性與迴腸造口有比較高的風險，106天以內關閉造口也有相對高的比例產生併發症。經過多變項分析後發現106天以內關閉腸造口是一獨立風險因子。在接受術前化學放射協同治療及低前位切除術後之局部廣泛性直腸癌病患早期關閉暫時性腸造口將增加手術相關之併發症。在這群患者究竟要選擇迴腸或是大腸作為暫時性腸造口以及造口關閉的適當時機仍需進一步以前瞻隨機性研究加以驗證。

關鍵字

暫時性腸造口 ； 直腸癌 ； 腸造口早期關閉

並列摘要

Creating a defunctioning stoma after radical proctectomy is vital for securing the anastomosis in patients with low-lying rectal cancer receiving concurrent chemoradiotherapy (CCRT). Although it reduces the complications and reoperation rate associated with anastomotic leakage, the complications developing before and after stoma closure should be carefully evaluated and managed. 83 patients who had locally advanced rectal cancer received neoadjuvant CCRT between July 2010 and November 2012 were enrolled in this study. A defunctioning stoma was created in 43 patients at the time of radical proctectomy and in additional three patients after anastomotic leakage. The total complication rate from stoma creation to closure was 30.4%. Ileostomy led to more renal insufficiency than colostomy and significantly increased the readmission rate. The complication rate related to stoma closure was 28.1%. Men and patients with ileostomy had an increased risk of developing complications, and time to closure <106 days yielded a higher incidence of morbidity. Multivariate analysis revealed that a time to closure <106 days was an independent risk factor. Early stoma closure was associated with a higher risk of developing complications related to stoma closure. The choice of defunctioning ileostomy or colostomy and the timing of closure in these patients should be verified in prospective, randomized clinical studies.

並列關鍵字

defunctioning stoma ； rectal cancer ； early closure of stoma

參考文獻

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