预防性回肠造瘘在腹腔镜直肠癌低位吻合根治术中的应用价值及造口方式探讨(1)
[摘要] 目的 研究預防性回肠造瘘在腹腔镜直肠癌低位吻合根治术中的应用价值。 方法 选择2012年5月～2017年12月收治的132例行低位吻合的直肠癌患者临床资料进行回顾性分析。所有患者均采用腹腔镜直肠癌低位吻合根治术，其中48例采用预防性改良襻式回肠末端造瘘(造瘘组)，84例未采用预防性改良襻式回肠末端造瘘(未造瘘组)。对两组患者术中和术后情况进行比较研究。 结果 造瘘组患者术后恢复明显快于未造瘘组，造瘘组术后肛门排气时间、进食时间、拔除盆腔皮管时间、住院时间均明显短于未造瘘组，差异有统计学意义(P<0.05);造瘘组和未造瘘组患者吻合口瘘发生率分别为0和10.71%(9/84)，差异有统计学意义(P<0.05);并发症发生率分别为16.67%(8/48)和21.43%(18/84)，差异无统计学意义(P>0.05)。改良襻式回肠末端造瘘术具有造瘘时间短、造口并发症较少、造口回纳简单等优点。 结论 对腹腔镜直肠癌行低位吻合根治术患者施行预防性改良襻式回肠末端造瘘，能有效降低吻合口瘘的发生，有利于患者快速康复。改良襻式回肠末端造瘘术，操作简单实用，值得推广。
[关键词] 预防性回肠造瘘术;直肠癌;吻合口瘘;低位吻合
[中图分类号] R735.3 [文献标识码] A [文章编号] 1673-9701(2019)08-0014-04
[Abstract] Objective To study the application value of preventive ileostomy in laparoscopic rectal cancer low anastomosis. Methods Clinical data of 132 patients with rectal cancer who were admitted to our hospital and were given low anastomosis from May 2012 to December 2017 were retrospectively analyzed. All patients were given laparoscopic rectal cancer low anastomosis. Among them， 48 patients were given preventive improved ileal terminal ostomy with a loop (ostomy group). 84 patients were not given preventive improved ileal terminal ostomy with a loop(non-ostomy group). A comparative study was performed between the two groups on intraoperative and postoperative conditions. Results The postoperative recovery of the patients in the ostomy group was significantly faster than that in the non-ostomy group. The anal exhaust time， eating time， pelvic tube removal time and length of hospital stay were significantly shorter in the ostomy group than those in the non-ostomy group(P<0.05); the incidence rate of anastomotic leakage was 0 and 10.71%(9/84) respectively in the ostomy group and non-ostomy group. and the difference was statistically significant(P<0.05); the complication rates were 16.67%(8/48) and 21.43%(18/84)， respectively， and the difference was not statistically significant(P>0.05). The improved ileal terminal ostomy with a loop has the advantages of short ostomy time， less ostomy complications， and simple ostomy return. Conclusion Preventive improved ileal terminal ostomy with a loop for the patients undergoing laparoscopic rectal cancer low anastomosis can effectively reduce the occurrence of anastomotic leakage and facilitate the rapid recovery of patients. Improved ileal terminal ostomy with a loop has simple and practical operation， which is worthy of promotion.
[Key words] Preventive ileostomy;Rectal cancer;Anastomotic fistula;Low anastomosis, 百拇医药(叶甫波 朱雄文 吴贵阳 袁世超 范庆豪)
[关键词] 预防性回肠造瘘术;直肠癌;吻合口瘘;低位吻合
[中图分类号] R735.3 [文献标识码] A [文章编号] 1673-9701(2019)08-0014-04
[Abstract] Objective To study the application value of preventive ileostomy in laparoscopic rectal cancer low anastomosis. Methods Clinical data of 132 patients with rectal cancer who were admitted to our hospital and were given low anastomosis from May 2012 to December 2017 were retrospectively analyzed. All patients were given laparoscopic rectal cancer low anastomosis. Among them， 48 patients were given preventive improved ileal terminal ostomy with a loop (ostomy group). 84 patients were not given preventive improved ileal terminal ostomy with a loop(non-ostomy group). A comparative study was performed between the two groups on intraoperative and postoperative conditions. Results The postoperative recovery of the patients in the ostomy group was significantly faster than that in the non-ostomy group. The anal exhaust time， eating time， pelvic tube removal time and length of hospital stay were significantly shorter in the ostomy group than those in the non-ostomy group(P<0.05); the incidence rate of anastomotic leakage was 0 and 10.71%(9/84) respectively in the ostomy group and non-ostomy group. and the difference was statistically significant(P<0.05); the complication rates were 16.67%(8/48) and 21.43%(18/84)， respectively， and the difference was not statistically significant(P>0.05). The improved ileal terminal ostomy with a loop has the advantages of short ostomy time， less ostomy complications， and simple ostomy return. Conclusion Preventive improved ileal terminal ostomy with a loop for the patients undergoing laparoscopic rectal cancer low anastomosis can effectively reduce the occurrence of anastomotic leakage and facilitate the rapid recovery of patients. Improved ileal terminal ostomy with a loop has simple and practical operation， which is worthy of promotion.
[Key words] Preventive ileostomy;Rectal cancer;Anastomotic fistula;Low anastomosis, 百拇医药(叶甫波 朱雄文 吴贵阳 袁世超 范庆豪)