保护性造口对直肠癌直肠低位前切除术器官腔隙感染的影响分析

 目的 了解保护性造口对行直肠低位前切除术（Dixon术）直肠癌患者术后器官腔隙感染的影响。方法 前瞻性监测2017-2021年某院实施Dixon术的直肠癌患者术后器官腔隙感染情况，分析感染危险因素，依据肿瘤距肛缘的距离将研究对象分为 ≥ 7 cm、5~7 cm和<5 cm三组，比较各组行保护性造口的比例及感染情况，以及行保护性造口与未行保护性造口患者的感染率。结果 2017-2021年该院行Dixon术的直肠癌患者器官腔隙感染率为4.79%（51/1 064）。危险因素分析显示，男性、术前贫血、术前肠梗阻、引流时间>10 d、肿瘤距肛门距离<7 cm、手术持续时间>3 h为发生器官腔隙感染的独立危险因素，而手术同时行保护性造口是发生器官腔隙感染的独立保护因素。肿瘤距肛门距离 ≥ 7 cm患者术后感染率最低，为2.76%；肿瘤距肛门5~7 cm患者感染率最高，为9.52%；肿瘤距肛门<5 cm患者行保护性造口比例最高，为72.05%。对于肿瘤距肛门距离 ≥ 7 cm患者，行保护性造口并不能有效预防感染的发生；对于肿瘤距肛门<5 cm患者，行保护性造口可明显降低感染率，差异有统计学意义（P=0.02）；肿瘤距肛门5~7 cm患者，行保护性造口后感染率降低幅度也很大，但差异无统计学意义（P=0.07）。结论 行保护性造口对直肠癌患者Dixon术后器官腔隙感染具有保护作用，尤其是对肿瘤距肛门距离<5 cm的患者。

Effect of protective stoma on organ space infection after low anterior rectal resection for rectal cancer

Objective To investigate the effect of protective stoma on organ space infection (OSI) in patients with rectal cancer after low anterior rectal resection (Dixon operation). Methods Post-operative OSI of rectal cancer patients who underwent Dixon operation in a hospital from 2017 to 2021 was monitored prospectively, risk factors for infection were analyzed, according to the distance from tumor to anal margin, patients were divided into three groups: ≥ 7 cm, 5-7 cm and <5 cm groups, proportion of protective stoma and infection of each group, as well as infection rates of patients with and without protective stoma were compared. Results From 2017 to 2021, OSI rate in rectal cancer patients undergoing Dixon operation was 4.79% (51/1 064). Risk factors analysis showed that male, pre-operative anemia, pre-operative intestinal obstruction, drainage time>10 days, distance from tumor to anus <7 cm, operation duration >3 hours were independent risk factors for OSI, and protective stoma was the independent protective factor for OSI. Patients with the distance from tumor to anus ≥ 7 cm had the lowest post-operative infection rate (2.76%); patients with the distance of 5-7 cm had the highest post-operative infection rate (9.52%); patients with the distance <5 cm had the highest proportion of protective stoma (72.05%). For patients with distance from tumor to anus ≥ 7 cm, protective stoma can not effectively prevent the occurrence of infection, while for patients whose distance was <5 cm, protective stoma can significantly reduce the infection rate, difference was significant (P=0.02); infection rate of patients with 5-7 cm from tumor to anus after protective stoma also decreased significantly, but difference was not significant (P=0.07). Conclusion Protective stoma has protective effect on OSI in rectal cancer patients after Dixon operation, especially in patients whose distance from tumor to anus is less than 5 cm.