直肠肛管恶性肿瘤腹会阴联合切除术中两种途径腹膜外乙状结肠造口的比较  

Comparison of different extraperitoneal sigmoidostomy in abdominoperineal resection for anorectal carcinoma

作　　者：胡毕文[1] 曹晨曦[1] 沈桂鑫[1] 陈振伟[1] 

机构地区：[1]嘉兴市第二医院肛肠外科,314033

出　　处：《浙江医学》2016年第3期198-200,共3页Zhejiang Medical Journal

摘　　要：目的探讨直肠肛管恶性肿瘤腹会阴联合切除术中两种途径腹膜外乙状结肠造口的临床应用价值。方法将行腹会阴联合切除术的67例直肠肛管恶性肿瘤患者,按腹膜外乙状结肠造口方式分为两组,其中A组34例(经腹内斜肌腹膜外造口),B组33例(经腹直肌外缘腹膜外造口),比较两组围手术期指标(手术时间、造口水肿、造口回缩塌陷、造口坏死、造口梗阻)和术后远期指标(腹胀感受、排便感觉、控便能力、造口旁疝、造口脱垂)的差异。结果两组均未发生造口回缩塌陷、造口梗阻、造口脱垂;在造口手术时间、造口水肿、造口坏死、排便感觉、腹胀感受和造口旁疝等方面比较,差异均无统计学意义(P>0.05);在控便能力方面A组明显优于B组(P<0.05)。结论两种腹膜外乙状结肠造口方式均安全可行,A种术武在预防造口旁疝方面可能有一定优势,适合普通患者;对于肠管较粗、系膜过于肥厚者适合B种术式。Objective To compare different extraperitoneal sigmoidostomy in abdominoperineal resection for anorectal carcinoma. Methods Sixty seven patients with anorectal carcinoma undergoing abdominoperineal resection were randomly divided into two group： 34 cases received extraperitoneal sigmoidostomy through internal oblique abdominis muscle （group A） and 33 cases received sigmoidostomy through exterior margin of rectus muscle （group B）. The operation time of sigmoidostomy, defecation feeling, ability to stool control and complications related to stoma were compared between two groups. Results There was no retraction, obstruction or prolapse of stoma in both groups. There was no significant differences in incidence of stoma operation time, stoma edema, stoma necrosis, defecation feeling and abdominal distention, parastomal hernia between two groups （P 〉0.05）. However the ability of stool control in group A was significant better than that in group B（P〈0.05）. Conclusion The two types of extraperitoneal sigmoidostomy are safe and feasible, but sigmoidostomy through internal oblique abdominis muscle may result in the better ability of stool control stool in patients.

关 键 词：腹会阴联合切除术 腹膜外乙状结肠造口 并发症 

分 类 号：R735.37[医药卫生—肿瘤]