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中华结直肠疾病电子杂志 ›› 2022, Vol. 11 ›› Issue (05) : 377 -383. doi: 10.3877/cma.j.issn.2095-3224.2022.05.005

论著

直肠癌前切除术后预置回肠造口与袢式回肠造口的对比研究
张成仁1, 吕耀春2,(), 杜斌斌2, 柳利利3, 路继永4, 王帅4, 杨熊飞2,()   
  1. 1. 750000 银川,宁夏医科大学;730000 兰州,甘肃省人民医院肛肠科;730000 兰州,甘肃省肛肠疾病临床医学研究中心
    2. 730000 兰州,甘肃省人民医院肛肠科;730000 兰州,甘肃省肛肠疾病临床医学研究中心
    3. 730000 兰州,甘肃中医药大学第一临床医学院
    4. 730000 兰州,甘肃省人民医院肛肠科;730000 兰州,甘肃省肛肠疾病临床医学研究中心;730000 兰州,甘肃中医药大学第一临床医学院
  • 收稿日期:2022-03-26 出版日期:2022-10-25
  • 通信作者: 吕耀春, 杨熊飞
  • 基金资助:
    甘肃省人民医院院内科研基金(20GSSY3-1,21GSSYC-20); 兰州市科学技术局基金(2022-ZD-47)

Comparative study between ghost ileostomy and defunctioning ileostomy in anterior resection for rectal cancer

Chengren Zhang1, Yaochun Lv2,(), Binbin Du2, Lili Liu3, Jiyong Lu4, Shuai Wang4, Xiongfei Yang2,()   

  1. 1. Ningxia Medical University, Yinchuan 750000, China; Department of Proctology, Gansu Provincial People's Hospital, Lanzhou 730000, China; Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou 730000, China
    2. Department of Proctology, Gansu Provincial People's Hospital, Lanzhou 730000, China; Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou 730000, China
    3. Department of First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial People's Hospital ), Lanzhou 730000, China
    4. Department of Proctology, Gansu Provincial People's Hospital, Lanzhou 730000, China; Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou 730000, China; Department of First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial People's Hospital ), Lanzhou 730000, China
  • Received:2022-03-26 Published:2022-10-25
  • Corresponding author: Yaochun Lv, Xiongfei Yang
引用本文:

张成仁, 吕耀春, 杜斌斌, 柳利利, 路继永, 王帅, 杨熊飞. 直肠癌前切除术后预置回肠造口与袢式回肠造口的对比研究[J/OL]. 中华结直肠疾病电子杂志, 2022, 11(05): 377-383.

Chengren Zhang, Yaochun Lv, Binbin Du, Lili Liu, Jiyong Lu, Shuai Wang, Xiongfei Yang. Comparative study between ghost ileostomy and defunctioning ileostomy in anterior resection for rectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2022, 11(05): 377-383.

目的

评估预置回肠造口(末段回肠预置于腹壁下)对比袢式回肠造口在腹腔镜直肠癌前切除术中的优势。

方法

进行前瞻性研究,纳入2020年1月至2021年12月甘肃省人民医院肛肠科收治的行腹腔镜直肠癌前切除术的患者,分为预置回肠造口组及袢式回肠造口组。主要的研究终点:首次住院以及术后3个月总体并发症指数(CCI);次要研究终点:术后吻合口漏发生率、肠梗阻发生率、手术时间、住院时间、住院费用、并发症Clavien-Dindo分级、术后3个月再次住院率以及肛门直肠功能(Wexner评分);其他研究终点:术后通气时间、首次进食时间、术后腹泻、手术时间>3 h、切缘阳性率以及术后病理pTNM分期。

结果

预置回肠造口组对比袢式回肠造口组的首次住院总体并发症评分(CCI评分)为(25.3±7.1 vs. 26.4±5.7),差异无统计学意义(t=0.456,P=0.067),而预置回肠造口组对比袢式回肠造口组术后3个月的CCI评分为(26.2±6.2 vs. 31.7±9.1),差异有统计学意义(t=0.283,P=0.041)。此外,预置回肠造口组患者对比袢式回肠造口组患者在手术时间(Z=-2.646,P=0.008)、住院时间(Z=-3.564,P=0.034)、住院费用(Z=-5.118,P=0.021)、术后3个月再次住院率(χ2=25.652,P=0.001)、术后3个月肛门直肠功能(t=-3.128,P=0.003)以及并发症Clavien-Dindo分级(χ2=9.692,P=0.021)等方面差异均具有统计学意义。

结论

预置回肠造口相对于袢式回肠造口是一种安全可行且经济有效的术式,但仅限于中低危吻合口漏患者。此外,本研究样本量较少且随访时间短,仍需后续试验加以验证。

Objective

To evaluate the advantages of ghost ileostomy versus defunctioning ileostomy in laparoscopic anterior resection for rectal cancer.

Methods

Patients undergoing laparoscopic anterior resection of rectal cancer admitted to the Department of Proctology of Gansu Provincial People's Hospital from January 2020 to December 2021 were enrolled and divided into ghost ileostomy group and defunctioning ileostomy group. Primary end points: comprehensive complication index(CCI); secondary end points: incidence of postoperative anastomotic leakage, incidence of intestinal obstruction, operation time, length of hospital stay, hospitalization cost, Clavien-Dindo classification of complications, re-hospitalization rate at 3 months after surgery, and anorectal function (Wexner score). Other end points included postoperative ventilation time, first feeding time, postoperative diarrhea, operation time >3 h, positive rate of surgical margin, and postoperative pathological pTNM stage.

Results

There was no significant difference in the CCI score of the first hospitalization between the ghost ileostomy group and the defunctioning ileostomy group (25.3±7.1 vs. 26.4±5.7) (t=0.456, P=0.067). However, the CCI score of the ghost ileostomy group was significantly different from that of the defunctioning ileostomy group at 3 months after operation (26.2±6.2 vs. 31.7±9.1) (t=0.283, P=0.041). In addition, there were significant differences in operation time (Z=-2.646, P=0.008), length of hospital stay (Z=-3.564, P=0.034), hospitalization cost (Z=-5.118, P=0.021), re-hospitalization rate at 3 months after operation (χ2=25.652, P=0.001), anorectal function at 3 months after operation (t=-3.128, P=0.003), and Clavien-Dindo classification of complications (χ2=9.692, P=0.021) between the ghost ileostomy group and the defunctioning ileostomy group.

Conclusion

Ghost ileostomy is a safe, feasible and cost-effective procedure compared to defunctioning ileostomy, but it is limited to patients with a moderate to low risk of anastomotic leakage. In addition, the sample size of this study is small and the follow-up time is short, which still needs to be verified in subsequent trials.

表1 预置回肠造口组和袢式回肠造口组的临床资料比较[
xˉ
±s,例(%)]
图1 末端回肠预置于腹壁下
图2 红色输尿管固定皮肤上
表2 预置回肠造口组和袢式回肠造口组术后比较[
xˉ
±s,例(%)]
[1]
Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2]
Ferlay J, Colombet M, Soerjomataram I, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018[J]. Eur J Cancer, 2018, 103: 356-387.
[3]
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019[J]. CA Cancer J Clin, 2019, 69(1): 7-34.
[4]
Fjederholt KT, Okholm C, Svendsen LB, et al. Ketorolac and other NSAIDs increase the risk of anastomotic leakage after surgery for GEJ cancers: a cohort study of 557 patients[J]. J Gastrointest Surg, 2018, 22(4): 587-594.
[5]
Rahbari NN, Weitz J, Hohenberger W, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer[J]. Surgery, 2010, 147(3): 339-351.
[6]
Sacchi M, Legge PD, Picozzi P, et al. Virtual ileostomy following TME and primary sphincter-saving reconstruction for rectal cancer[J]. Hepatogastroenterology, 2007, 54(78): 1676-1678.
[7]
Slankamenac K, Graf R, Barkun J, et al. The comprehensive complication index: a novel continuous scale to measure surgical morbidity[J]. Ann Surg, 2013, 258(1): 1-7.
[8]
Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer[J]. Lancet, 1986, 1(8496): 1479-1482.
[9]
Cheng S, He B, Zeng X. Prediction of anastomotic leakage after anterior rectal resection[J]. Pak J Med Sci, 2019, 35(3): 830-835.
[10]
Hüttner FJ, Probst P, Mihaljevic A, et al. Ghost ileostomy versus conventional loop ileostomy in patients undergoing low anterior resection for rectal cancer (DRKS00013997): protocol for a randomised controlled trial[J]. BMJ Open, 2020, 10(10): e038930.
[11]
Sciuto A, Merola G, De Palma GD, et al. Predictive factors for anastomotic leakage after laparoscopic colorectal surgery[J]. World J Gastroenterol, 2018, 24(21): 2247-2260.
[12]
Kostov GG, Dimov RS, Almeida DD. Risk factors for anastomotic leakage after low anterior resection[J]. Folia Med (Plovdiv), 2020, 62(2): 290-294.
[13]
Gonzalez-Valverde FM, Vicente-Ruiz M, Gomez-Ramos MJ. Risk factors of anastomotic leakage in colon cancer[J]. Cir Cir, 2019, 87(3): 347-352.
[14]
Kryzauskas M, Bausys A, Degutyte AE, et al. Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery[J]. World J Surg Oncol, 2020, 18(1): 205.
[15]
Yao H, An Y, Zhang Z. The application of defunctioning stomas after low anterior resection of rectal cancer[J]. Surg Today, 2019, 49(6): 451-459.
[16]
Garg PK, Goel A, Sharma S, et al. Protective diversion stoma in low anterior resection for rectal cancer: a meta-analysis of randomized controlled trials[J]. Visc Med, 2019, 35(3): 156-160.
[17]
Phan K, Oh L, Ctercteko G, et al. Does a stoma reduce the risk of anastomotic leak and need for re-operation following low anterior resection for rectal cancer: systematic review and meta-analysis of randomized controlled trials[J]. J Gastrointest Oncol, 2019, 10(2): 179-187.
[18]
Marchegiani F, Barina A, Spolverato G, et al. Defunctioning stoma in young patients affected by rectal cancer: a delicate balance[J]. Br J Surg, 2020, 107(12): e639.
[19]
Zhang L, Zheng W, Cui J, et al. Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery[J]. Chronic Dis Transl Med, 2020, 6(3): 188-197.
[20]
Hanna MH, Vinci A, Pigazzi A. Diverting ileostomy in colorectal surgery: when is it necessary?[J]. Langenbecks Arch Surg, 2015, 400(2): 145-152.
[21]
Huser N, Michalski CW, Erkan M, et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery[J]. Ann Surg, 2008, 248(1): 52-60.
[22]
Gullà N, Trastulli S, Boselli C, et al. Ghost ileostomy after anterior resection for rectal cancer: a preliminary experience[J]. Langenbecks Arch Surg, 2011, 396(7): 997-1007.
[23]
Mari FS, Di Cesare T, Novi L, et al. Does ghost ileostomy have a role in the laparoscopic rectal surgery era? A randomized controlled trial[J]. Surg Endosc, 2015, 29(9): 2590-2597.
[24]
Zenger S, Gurbuz B, Can U, et al. Comparative study between ghost ileostomy and defunctioning ileostomy in terms of morbidity and cost-effectiveness in low anterior resection for rectal cancer[J]. Langenbecks Arch Surg, 2021, 406(2): 339-347.
[25]
Mori L, Vita M, Razzetta F, et al. Ghost ileostomy in anterior resection for rectal carcinoma: is it worthwhile?[J]. Dis Colon Rectum, 2013, 56(1): 29-34.
[26]
Cerroni M, Cirocchi R, Morelli U, et al. Ghost Ileostomy with or without abdominal parietal split[J]. World J Surg Oncol, 2011, 9: 92.
[27]
Baloyiannis I, Perivoliotis K, Diamantis A, et al. Virtual ileostomy in elective colorectal surgery: a systematic review of the literature[J]. Tech Coloproctol, 2020, 24(1): 23-31.
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