背景:在直肠癌手术的情况下,吻合口漏高危患者常接受造口功能失效(DS).然而,其在术后吻合口狭窄(AS)中的作用尚不清楚。本研究旨在探讨DS和AS与经肛门内镜显微手术(TEM)治疗直肠AS疗效的相关性。
方法:这项回顾性研究于2019年1月至2021年9月进行,包括接受直肠癌手术的患者。1:1的比例用于倾向评分匹配(PSM)。进行单变量分析以确定具有统计学意义的变量,并进行多变量分析以确定影响AS的因素。
结果:本研究包括383例患者。单因素分析结果提示手术时间(HR4.597,95%CI1.563-13.525,P=0.006),术后吻合口漏(HR11.830,95%CI3.773-37.094,P<0.001),DS(HR15.475,95%CI6.042-39.641,P<0.001)与AS显着相关。在多变量分析中,术后吻合口漏(HR7.596,95%CI1.987-29.044,P=0.003)和DS(HR11.252,95%CI4.113-30.779,P<0.001)是AS的显著危险因素.匹配后,单因素分析显示术后吻合口漏(HR8.333,95%CI1.541-45.052,P=0.014)和DS(HR9.965,95%CI2.200-45.142,P=0.003)与AS相关。多因素分析显示,术后吻合口漏(HR14.549,95%CI1.765~119.913,P=0.013)和DS(HR12.450,95%CI2.418~64.108,P=0.003)是AS的危险因素。
结论:这项研究提供了证据,表明DS与AS独立相关,术后吻合口漏增加AS的风险。此外,这项研究表明,TEM可能是AS的一种有价值的治疗选择。
BACKGROUND: In cases of rectal cancer surgery, patients at high risk of anastomotic leakage often receive a defunctioning stoma (DS). However, its role in postoperative anastomotic strictures (AS) remains unclear. This study aimed to investigate the correlation between DS and AS and outcomes of transanal endoscopic microsurgery (TEM) in treating rectal AS.
METHODS: This retrospective study was conducted from January 2019 to September 2021 and included patients who underwent rectal cancer surgery. A 1:1 ratio was used for propensity score matching (PSM). Univariate analyses were performed to identify statistically significant variables, and multivariate analyses were conducted to determine the factors affecting AS.
RESULTS: This study included 383 patients. The results of the univariate analysis suggested that surgery time (HR 4.597, 95% CI 1.563-13.525, P=0.006), postoperative anastomotic leakage (HR 11.830, 95% CI 3.773-37.094, P<0.001), and DS (HR 15.475, 95% CI 6.042-39.641, P<0.001) were significantly associated with AS. In the multivariate analysis, postoperative anastomotic leakage (HR 7.596, 95% CI 1.987-29.044, P= 0.003) and DS (HR 11.252, 95% CI 4.113-30.779, P<0.001) were identified as significant risk factors for AS. After matching, the univariate analysis revealed that postoperative anastomotic leakage (HR 8.333, 95% CI 1.541-45.052, P= 0.014) and DS (HR 9.965, 95% CI 2.200-45.142, P= 0.003) were associated with AS. The multivariate analysis indicated that postoperative anastomotic leakage (HR 14.549, 95% CI 1.765-119.913, P= 0.013) and DS (HR 12.450, 95% CI 2.418-64.108, P= 0.003) were significant risk factors for AS.
CONCLUSIONS: This study provides evidence that DS is independently associated with AS, and postoperative anastomotic leakage increases the risk of AS. Furthermore, this study suggests that TEM could be a valuable treatment option for AS.