Risk factor analysis on postoperative complications after laparoscopic total mesorectal excision with preventive terminal ileostomy and timing of stoma closure in rectal cancer
10.3760/cma.j.issn.1671-0274.2015.06.012
- VernacularTitle:腹腔镜直肠癌全直肠系膜切除术预防性末端回肠造瘘后相关并发症危险因素和造瘘还纳时机分析
- Author:
Lingduo XIE
1
;
Xin ZHOU
;
Haiting XIE
;
Yunkai ZHANG
;
Huanhong ZENG
;
Tao SUN
;
Ning CHEN
;
Wei FU
Author Information
1. 100191,北京大学第三医院普通外科
- Keywords:
Rectal neoplasms;
Preventive Terminal Ileostomy;
Complications;
Stoma Closure
- From:
Chinese Journal of Gastrointestinal Surgery
2015;(6):563-567
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the application of protective terminal ileostomy in laparoscopic total mesorectal excision for rectal cancer patients , and explore the risk factors associated with postoperative complications and timing of stoma closure. Methods Clinical data of 77 patients with middle or low rectal cancer undergoing laparoscopic total mesorectal excision (TME) with preventive terminal ileostomy in our department from January 2007 to December 2013 were retrospectively analyzed . Independent risk factors associated to postoperative complications of terminal ileostomy were examined by logistic regression and timing of stoma closure was investigated . Result The total postoperative complication morbidity was 57.1%(44/77). Electrolyte disturbance was found in 39 cases (50.6%, 39/77), including 1 case of hypovolemic syncope. Parastomal hernia occurred in 9 cases (11.7%, 9/77). Peristomal dermatitis and subcutaneous abscess was observed in 1 case (1.3%, 1/77). The result of the single factor analysis of the water electrolyte disturbance after operation, the risk factors of P<0.2 were new adjuvant chemotherapy (P=0.094), tumor antigen (P=0.086) and TNM staging (P=0.026); Postoperative parastomal hernia of the single factor analysis results, the risk factors of P<0.2 included uses of antidiabetic drugs (P=0.172), ASA anesthesia (P=0.168) grading and TNM stage (P=0.161); But multivariate analysis revealed no risk factors associated with the above complications (all P>0.05). Sixty-five patients underwent stoma closure during follow-up, including 2 cases (3.1%) within 90 days, 20 cases (30.8%) from 90 to 180 days, and 43 cases (66.2%) more than 180 days. Conclusions No risk factors were found to be associated with main postoperative complications of protective terminal ileostomy after laparoscopic TME for rectal cancer patients, such as electrolytes imbalance and parastomal hernia. The timing of stoma closure should be longer than 180 days.
