支架法转流术在低位直肠癌前切除术中的初步应用效果：单中心探索性分析

Preliminary Application of the Stent Diversion Technique in Low Anterior Resection for Low Rectal Cancer: A Single-Center Exploratory Analysis

摘要: 目的：探讨支架法转流术(the stent diversion technique, SDT)与保护性回肠造口在低位直肠癌前切除术中的安全性和有效性差异。方法：本研究为一项基于多中心前瞻性随机对照试验数据库的单中心探索性分析。回顾性收集2024年3月至2025年6月于四川省肿瘤医院大肠外科接受治疗的28例低位直肠癌患者临床资料。所有患者均来源于多中心前瞻性临床试验数据库。其中，13例行低位前切除术联合支架转流术(SDT组)，15例行低位前切除术联合保护性回肠造口术(Ileostomy组)。对两组患者的基线特征、围手术期相关指标、术后恢复情况、术后并发症及住院相关指标进行比较分析。结果：两组在年龄、性别构成、BMI、TNM分期、肿瘤大小及既往手术史等基线特征方面比较，差异均无统计学意义(均P > 0.05)。围手术期指标方面，两组在手术时长、术中失血量、术后首次排气时间及排气至排便恢复时间等指标上的差异均无统计学意义(均P > 0.05)。术后总体并发症发生率方面，SDT组为15.4%，Ileostomy组为26.7%，组间比较差异无统计学意义(P > 0.05)。两组在单次住院时间和住院费用方面差异亦均无统计学意义(均P > 0.05)。研究期间，两组患者均未出现严重吻合口漏及围手术期死亡事件。结论：本单中心探索性分析结果显示，在本小样本队列中，支架法转流术(SDT)具有初步的可行性和安全性，未观察到较保护性回肠造口更高的围手术期并发症发生率或吻合口相关不良事件，同时避免了体外造口及二次还纳手术。

Abstract: Objective: To investigate the differences in safety and efficacy between the stent diversion technique (SDT) and protective ileostomy in low anterior resection for low rectal cancer. Methods: This study was a single-center exploratory analysis based on a multicenter prospective randomized controlled trial database. Clinical data of 28 patients with low rectal cancer treated at the Department of Colorectal Surgery, Sichuan Cancer Hospital between March 2024 and June 2025 were retrospectively collected. All patients were enrolled from a multicenter prospective clinical trial database. Among them, 13 patients underwent low anterior resection combined with stent diversion (SDT group), and 15 patients underwent low anterior resection combined with protective ileostomy (Ileostomy group). Baseline characteristics, perioperative indicators, postoperative recovery, postoperative complications, and hospitalization-related indicators were compared and analyzed between the two groups. Results: There were no statistically significant differences between the two groups in baseline characteristics including age, sex composition, BMI, TNM stage, tumor size, and history of previous surgery (all P > 0.05). Regarding perioperative indicators, no statistically significant differences were observed between the two groups in operative duration, intraoperative blood loss, time to first postoperative flatus, or time from flatus to bowel movement recovery (all P > 0.05). The overall incidence of postoperative complications was 15.4% in the SDT group and 26.7% in the Ileostomy group, with no statistically significant difference between groups (P > 0.05). There were also no statistically significant differences between the two groups in single hospitalization duration or hospitalization costs (all P > 0.05). During the study period, no patients in either group experienced severe anastomotic leakage or perioperative mortality. Conclusion: The results of this single-center exploratory analysis suggest that, in this small-sample cohort, the stent diversion technique (SDT) demonstrates preliminary feasibility and safety. No higher incidence of perioperative complications or anastomosis-related adverse events was observed compared with protective ileostomy, while avoiding external stoma creation and secondary reversal surgery.