标准化创新：在肿瘤细胞减灭术中降低回肠造口率并追求零吻合口漏
该研究在卵巢癌行直肠乙状结肠切除的肿瘤细胞减灭术中，修订方案以降低预防性造口而不增加吻合口漏。
要点
- 修订方案后预防性造口率从31.3%降至16.4%，吻合口漏未增加。
- 修订方案包括吲哚菁绿灌注映射、取消多发大肠切除作为造口指征及调整白蛋白阈值。
- 修订队列造口最常见原因为吻合口距肛缘≤6 cm（10例）。
核心结论
- 使用修订方案可降低预防性造口率而不增加吻合口漏。
- 造口减少主要与在修订方案下对经仔细选择和评估的多发大肠切除患者避免造口有关。
研究设计与样本
- 采用描述性统计、卡方检验、Fisher精确检验和Wilcoxon双样本检验比较差异。
主要发现
- 修订方案组与历史队列的中位年龄和BMI相似。
- 修订方案组新辅助化疗使用率为33.6%，历史队列为17.9%（p=0.02）。
- 多发大肠切除比例分别为17.9%和19.7%（p=0.77）。
- 吻合口漏率分别为0.8%和3%。
- 造口率分别为16.4%和31.3%（p=0.02）。
关键数值与推荐
- 修订方案包括吲哚菁绿灌注映射、取消多发大肠切除作为造口指征及更改最低白蛋白水平。
- 修订队列中造口最常见原因为吻合口≤6 cm，共10例。
临床怎么用
- 在卵巢癌肿瘤细胞减灭术行直肠乙状结肠切除时，可采用修订方案以降低不必要的预防性造口。
- 对经仔细选择和评估的多发大肠切除患者，可避免预防性造口而不增加吻合口漏风险。
局限性
- 回顾性分析两个前瞻性队列，可能存在选择偏倚。
- 修订方案组新辅助化疗使用率显著高于历史队列，可能影响结果比较。
- 样本量有限，结论需进一步验证。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: Anastomotic leak (AL) following rectosigmoid resection (RSR) is a key driver of postoperative morbidity and early mortality in ovarian cancer (OC). We previously reported a prospective study reducing AL but resulting in a high rate of prophylactic diversion. We refined the protocol to reduce prophylactic diversion without increasing AL. METHODS: Retrospective analysis of two prospective cohorts with implementation of a revised protocol intended to reduce unnecessary prophylactic diversions began November 2016 with analysis through July 2024 for differences using descriptive statistics, Chi-square, Fisher's exact, and Wilcoxon two-sample tests. Protocol revisions included indocyanine green perfusion mapping, removal of multiple large bowel resections (LBR) as a diversion criterion and a change in the minimum albumin level. RESULTS: One hundred and twenty-two patients with OC underwent cytoreduction with RSR from 2016 to 2024 utilizing the revised protocol. Outcomes were compared to a previously published cohort of 67 patients from 2012 to 2016. Median age and BMI were similar between the cohorts. Neoadjuvant chemotherapy was used for 33.6% in the revised protocol period versus 17.9% (p = 0.02). The proportion of multiple LBR was similar (17.9% versus 19.7%, respectively, p = 0.77). The rate of AL was similar (0.8% versus 3%). The diversion rates were 16.4% vs. 31.3% (p = 0.02). The most common reason for diversion in the revised cohort was anastomosis ≤6 cm in 10 cases. CONCLUSIONS: Use of a modified protocol resulted in a lower prophylactic diversion rate without an increase in AL. The reduction in prophylactic diversion was primarily related to avoidance in carefully selected and assessed patients who underwent multiple LBR under the revised protocol.
引用
- Langstraat CL, Ostby SA, Vu A, et al. Innovation through standardization: Reducing the ileostomy rates while targeting zero anastomotic leaks at cytoreductive surgery. Gynecol Oncol. 2026. PMID: 42172993. doi:10.1016/j.ygyno.2026.05.009
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。