保护性造口在超低位直肠肿瘤内括约肌切除术中的价值  

Value of protective stoma in intersphincteric resection for ultra-low rectal cancer

作　　者：左志贵[1] 宋华羽[1] 徐昶[1] 李激[1] 倪士昌[1] 周振华[1] 陈绍棋[1] 

机构地区：[1]温州医学院附属第一医院肛肠外科,325000

出　　处：《中华外科杂志》2010年第19期1479-1483,共5页Chinese Journal of Surgery

摘　　要：目的 探讨保护性造口在超低位直肠肿瘤内括约肌切除术（ISR）中的应用价值.方法 对1999年1月至2009年7月给予经肛ISR联合经腹全直肠系膜切除术结肠肛管吻合术的56例无肛门外括约肌受侵的超低位直肠肿瘤患者的临床资料进行回顾性分析,比较造口组（16例）与未造口组（40例）患者术后吻合口和肛门部并发症及肛门功能恢复情况.结果 56例患者中16例（28.6%）行保护性造口.未造口组术后吻合口和肛门部并发症分别出现14例（35.0%）和16例（40.0%）,而造口组吻合口及肛门部并发症分别仅出现1例（1/16）,两组差异有统计学意义（P〈0.05）.未造口组1例吻合口裂开肿瘤复发再手术行永久性结肠造口,另3例吻合口及肛门病变需造口及二期手术治疗,再手术率为10.0%.两组患者术后肛门控便能力均下降,造口组患者造口回纳术后3、6、12个月肛门功能Kirwan评分达Ⅰ级者分别为11/16、13/15、11/13,未造口组患者术后3、6、12个月达Ⅰ级比例分别为30.0%、37.5%、45.0%,术后同期造口组患者肛门功能均明显优于未造口组患者（P〈0.05）.结论 保护性肠造口可减少超低位直肠肿瘤ISR后吻合口瘘,消除术后早期肛门失禁给患者带来的痛苦,且有利于肛门功能的恢复.Objective To investigate the value of protective stoma in intersphincteric resection （ISR）for ultra-low rectal cancer. Methods Clinical data of 56 ultra-low rectal cancer patients without involvement of external anal sphincter treated during January 1999 to July 2009 with trans-anal ISR plus trans-abdominal total mesorectum excision and coloanal anastomosis were retrospectively analyzed. The patients were divided into two groups based on whether they received protective ostomy： ostomy group （16 cases）and ostomy-frec group（40 cases）. The postoperative complications as well as anal functional restoration were compared between the two groups. Results Sixteen cases （32. 1%）of the 56 patients received protective stoma. The complication rate of anastomosis and anus complication rate in the ostomy-free group were significantly higher than those in ostomy group [35.0% （14/40）and 40. 0% （16/40）vs. 1/16 and 1/16;P 〈0. 05]. In the ostomy-free group, one patient developed anastomotic dehiscence and tumor recurrence, the patients was given permanent colostomy, and the other three patients with lesions in the anastomosis and anus received ostomy and secondary surgical treatment, with a reoperation rate of 10. 0%（4/40）. The anal function of patients in the two groups were both decreased after the operation. The rate of patients got Kirwan grade Ⅰ anal sphincter function in the 3rd, 6th and 12th month after protective stoma operation was 11/16, 13/15 and 11/13 in the ostomy group, respectively; and those were 30. 0%, 37.5% and 45. 0% in the ostomy-free group, respectively. Anal function was significantly better in the ostomy group than that in the ostomy-free group during the same postoperative period（P〈0.05）. Conclusion Protective stoma can avoid anastomotic leakage following ISR for ultra-low rectal cancer, and alleviate the suffering of anal incontinence in the early postoperative period, and is conducive to the restoration of anal function.

关 键 词：直肠肿瘤 内括约肌切除术 保护性造口 

分 类 号：R686[医药卫生—骨科学]