摘要目的:探讨直肠癌手术预防性回肠造口术后还纳失败的预后因素。方法:回顾性分析2013年1月至2020年6月首都医科大学附属北京友谊医院普外科收治的234例直肠癌根治术预防性回肠造口患者的临床和病理学资料。男性166例，女性68例，年龄［ M（IQR）］62（12）岁（范围：33~89岁）。于2021年7月集中进行电话随访，重点了解患者造口是否还纳、还纳失败原因及肿瘤术后复发或转移情况；还纳失败定义为术后超过12个月未能还纳。使用χ2检验或Fisher确切概率法对还纳失败相关的临床指标进行单因素分析，将 P<0.05的因素纳入Logistic回归进行多因素分析。 结果:共165例患者术后造口还纳成功，还纳时间为（6.5±2.4）个月（范围：0.9~17.8个月），69例患者还纳失败。单因素分析结果显示，年龄、合并症、手术方式、术前血红蛋白、术前癌胚抗原、肿瘤最大径、浸润深度、淋巴结转移、TNM分期、吻合口相关并发症、术后局部复发或远处转移与预防性回肠造口术后还纳失败相关（ P值均<0.05）。多因素分析结果显示，年龄>65岁（ OR=2.270，95% CI：1.150~4.479， P=0.018）、开腹手术（ OR=7.249，95% CI：1.977~26.587， P=0.003）、术前血红蛋白<120 g/L（ OR=3.092，95% CI：1.566~6.105， P<0.01）、吻合口相关并发症（ OR=4.375，95% CI：1.686~11.349， P=0.002）、局部复发或远处转移（ OR=7.065，95% CI：2.591~19.264， P<0.01）是直肠癌手术预防性回肠造口术后还纳失败的预后因素。 结论:对于年龄>65岁、拟行开腹手术、术前血红蛋白<120 g/L的直肠癌患者，预防性回肠造口有还纳失败的风险，应充分评估后进行选择。减少吻合口相关并发症，有助于成功还纳预防性回肠造口。

abstractsObjective:To examine the prognosis factors for non-reversal of defunctioning ileostomy in rectal cancer surgery.Methods:The data of 234 patients with rectal cancer undergoing radical resection and defunctioning ileostomy in the Department of General Surgery, Beijing Friendship Hospital, Capital Medical University from January 2013 to June 2020 was analyzed retrospectively. There were 166 males and 68 females, aging ( M(IQR)) 62(12) years (range: 33 to 89 years). Telephone following-up was conducted intensively in July 2021 to investigate whether stoma was reversed, causes of reversal failure, and tumor recurrence or metastasis after surgery. The non-reversal stoma was defined as stoma not being reversed during the follow-up period (more than 12 months). The χ 2 test or Fisher′s exact test was used to conduct a univariate analysis of clinical data related to reversal failure, and the factors with P<0.05 were selected into Logistic regression for multivariate analysis. Results:A total of 165 patients received stoma reversal postoperatively with an interval time of (6.5±2.4) months (range: 0.9 to 17.8 months), but 69 patients failed to closure of stoma. Univariate analysis showed that age, concomitant diseases, surgical methods, preoperative hemoglobin, preoperative carcinoembryonic antigen, tumor maximum diameter, depth of invasion, lymph node metastasis, TNM stage, anastomotic-related complications, postoperative tumor local recurrence or distant metastasis were associated with non-reversal of diverting ileostomy in rectal cancer surgery (all P<0.05). Multivariate analysis showed that age ( OR=2.270, 95% CI: 1.150 to 4.479, P=0.018), open surgery ( OR=7.249, 95% CI: 1.977 to 26.587, P=0.003), preoperative hemoglobin<120 g/L ( OR=3.092, 95% CI: 1.566 to 6.105, P<0.01), anastomotic-related complications ( OR=4.375, 95% CI: 1.686 to 11.349, P=0.002), postoperative local recurrence or distant metastasis ( OR=7.065, 95% CI: 2.591 to 19.264, P<0.01) were independent prognosis factors for reversal failure of defunctioning stoma in rectal cancer surgery. Conclusions:There is a high risk of reversal failure of defunctioning ileostomy among rectal cancer patients with age>65 years, open surgery, preoperative hemoglobin<120 g/L, anastomotic-related complications, postoperative local recurrence or distant metastasis. Colorectal surgeons should fully evaluate the outcome and risk of reversal failure before making a decision of diverting ileostomy. Reducing anastomotic complications is helpful to the successful return of preventive ileostomy.