文章摘要
直肠癌新辅助放化疗联合直肠前切除术及预防性造瘘患者永久性造口形成的危险因素及预后分析
Analysis of risk factors of neoadjuvant radiotherapy and chemotherapy combined with anterior rectal resection and preventive fistula for permanent stoma in rectal cancer
投稿时间：2021-01-08  
DOI：10.3969/j.issn.1000-0399.2021.07.003
中文关键词: 直肠癌  新辅助放化疗  永久性造口
英文关键词: Rectal cancer  Neoadjuvant chemoradiotherapy  Permanent ostomy
基金项目:2019年度河南省医学科技攻关计划联合共建项目（项目编号：LHGJ20191391）
作者单位
张巍巍 461000 河南省许昌市中心医院普通外科一病区 
徐华 461000 河南省许昌市中心医院普通外科一病区 
胡江伟 461000 河南省许昌市中心医院普通外科一病区 
刘士凯 461000 河南省许昌市中心医院普通外科一病区 
李天生 461000 河南省许昌市中心医院普通外科一病区 
张智博 461000 河南省许昌市中心医院普通外科一病区 
牛阿贞 461000 河南省许昌市中心医院普通外科一病区 
菅书明 461000 河南省许昌市中心医院普通外科一病区 
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中文摘要:
      目的 分析中低位直肠癌患者术前接受新辅助放化疗联合直肠前切除术和术后预防性造瘘治疗后，形成永久性造口的危险因素。方法 收集2015年1月至2016年12月在许昌市中心医院接受术前新辅助放化疗联合直肠前切除术和预防性造瘘术的直肠癌患者164例，根据术后4年随访结果，将患者分为永久性造口组（39例）和造口还纳成功组（135例）。比较两组一般资料、吻合口相关并发症，单因素和多因素logistic回归模型分析影响患者永久性造口形成的独立危险因素。采用Kaplan Meier法比较两组的1、3年总生存率和无瘤生存率。结果 多因素logistic回归分析结果显示，肿瘤距肛缘距离[OR（95% CI）：0.526（0.305~0.847），P=0.014]、吻合口漏[OR（95% CI）：0.965（0.748~1.854），P=0.021]、吻合口狭窄[OR（95% CI）：1.205（1.006~1.954），P=0.038]和局部复发[OR（95% CI）：1.305（1.047~1.532），P=0.038]为影响永久性造口形成的独立危险因素。永久性造口组术后1年总生存率、1年无瘤生存率和3年无瘤生存率分别为89.7%、71.8%和53.8%，与造口还纳成功组比较，差异无统计学意义（P＞0.05）。永久性造口组术后3年总生存率为69.2%，低于造口还纳成功组的85.2%（χ2=4.527，P=0.033）。结论 肿瘤距肛缘距离、吻合口漏、吻合口狭窄和局部复发为影响永久性造口形成的独立危险因素，且永久性造口影响患者术后3年总生存率。
英文摘要:
      Objective To analyze the risk factors of permanent stoma after neoadjuvant radiotherapy + anterior rectal resection + postoperative preventive fistula treatment in patients with middle and low rectal cancer and compare the survival rates between different groups. Methods From January 2015 to December 2016, 164 patients with rectal cancer who underwent preoperative neoadjuvant chemotherapy combined with anterior rectal resection and postoperative preventive fistula surgery in Xuchang Central Hospital were recruited, including 105 males and 59 females, at the age of (56.2±7.3) years old. According to the 4-year follow-up results, the patients were divided into permanent stoma group and stoma reduction group. The general clinical data and anastomotic-related complications between the two groups were compared, and statistically different indicators were brought into the logistic regression model to analyze the independent risk factors affecting the formation of permanent stoma. Results The results of multivariate regression analysis showed that the distance between the tumor and the anal margin[OR(95%CI)=0.526(0.305~0.847), P=0.014], anastomotic fistula[OR(95%CI)=0.965(0.748~1.854), P=0.021], anastomotic stenosis[OR(95%CI)=1.205(1.006~1.954), P=0.038] and local recurrence[OR(95%CI)=1.305(1.047~1.532), P=0.038] were independent risk factors affecting the formation of permanent stoma. The 1-year overall survival rate, 1-year tumor-free survival rate, and 3-year tumor-free survival rate of the permanent ostomy group was 89.7%, 71.8%, and 53.8%, respectively, which was not statistically different from the successful ostomy group. The 3-year overall survival rate of the permanent stoma group was 69.2%, which was lower than that of the successful stoma group by 85.2%, χ2=4.527, P=0.033. Conclusions Tumor distance from the anal margin, anastomotic leakage, anastomotic stenosis, and local recurrence are independent risk factors that affect the formation of permanent stoma, and the permanent ostomy influences the 3-year overall postoperative survival rate.
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