直肠癌新辅助放化疗后预防回肠造口与吻合口漏相关性研究

目的探讨研究保护性回肠造口是否可以降低直肠癌新辅助治疗患者术后吻合口漏的发病率及相关性。方法选取首都医科大学附属北京友谊医院2011年5月-2020年8月直肠癌新辅助放化疗行直肠癌前切除术的患者108例实施保护性回肠造口(试验组)63例,未实施保护性回肠造口(对照组)45例。主要比较两组患者吻合口漏发病率,同时分析吻合口漏相关因素,统计永久造口率。采用SPSS 19.0软件进行统计分析、结果试验组和对照组术后吻合口漏的总发病率分别为9.52%(6/63)和6.66%(3/45)(P=0.59),其中试验组发生A级吻合口漏2例,对照组无A级吻合口漏,两组差异无统计学意义(33.33%比0,P=0.77);试验组发生B级吻合口漏4例,对照组2例,两组差异无统计学意义(66.67%比66.67%,P=0.45);试验组无C级吻合口漏.对照组发生C级吻合口漏1例,两组差异无统计学意义(0比33.33%,P=0.70)。Logistic回归分析显示实施保护性造口与否同吻合口漏的发生无关(P=0.26),肿瘤距肛缘距离关系吻合口漏的发生(P=0.01)。试验组术后永久造口率为9/63(16.67%)。结论保护性回肠造口在降低直肠癌新辅助放化疗患者术后吻合口漏发病率方面并无显著优势,并有可能导致永久造口。

Study on the relationship between protective ileostomy and anastomotic leakage after neoadjuvant radiotherapy and chemotherapy for rectal cancer

Objective To explore whether the protective ileostomy can reduce the incidence of anastomotic leakage after neoadjuvant treatment of rectal cancer and the relationship between protective ileostomy and anastomotic leakage.Methods From May 2011 to August 2020,a total of 108 patients who underwent rectal cancer neoadjuvant radiotherapy and chemotherapy and then received anterior resection in Beijing Friendship Hospital,Capital Medical University were selected.Sixty-three cases were treated with protective ileostomy(Treatment group),while 45 cases were not(Control group).The chi-square test was used to compare the incidence of anastomotic leakage between the two groups.At the same time,Logistic regression was used to analyze the related factors of anastomotic leakage,and the rate of pennanent stoma was calculated.SPSS19.0 software was used for statistical analysis.Results The total incidence of postoperative anastomotic leakage in the Treatment group and Control group was 9.52%(6/63)and 6.66%(3/45)(P=0.59).Among them,2 cases of anastomotic leakage occurred in the Treatmentgroup,no A-grade anastomotic leakage occurred in the Control group,and there was no significant difference between the two groups(33.33%vs.0,P=0.77).There were 4 cases of grade B anastomotic leakage occurred in the Treatment group,2 cases in the Control group,there was no significant difference between the two groups(66.67%vs.66.67%,P=0.45).There was no grade C anastomotic leakage in the Treatment group,and one case of grade C anastomotic leakage occurred in the Control group,there was no significant difference between the two groups(0 to 33.33%,P=0.70).Logistic regression analysis showed that whether protective stoma was implemented or not was not statistically related to the occurrence of anastomotic leakage(P=0.26).The distance between the tumor and the anal margin(P=0.01)affected the occurrence of anastomotic leakage.The permanent stoma rate in the Treatment group was 9/63(16.67%).Conclusion Protective ileostomy has no significant advantage in reducing the incidence of anastomotic leakage in patients with rectal cancer neoadjuvant radiotherapy and chemotherapy,and may lead to permanent stoma.