低位直肠癌保肛中预防性造口的临床应用分析  

Defunctioning stoma in sphincter-preserving surgery for low rectal cancer: a retrospective clinical analysis

作　　者：张勇[1] 郭子健[1] 曹华祥[1] 周俊晶[1] 戴赛民[1] 赵长勇[1] 鱼海峰[1] 

机构地区：[1]江南大学附属医院(无锡市第四人民医院)普外科,214062

出　　处：《中华普外科手术学杂志（电子版）》2016年第2期133-136,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探讨预防性造口在低位直肠癌保肛术中的临床应用价值。方法分析2010年3月至2013年10月期间收治的37例低位直肠癌保肛术患者的临床资料,两组患者术前均经病理检查确诊,癌灶下缘距肛缘小于7 cm。将患者分成预防性造口组（19例）、未施行预防性造口组（18例）,应用SPSS17.0对相关数据进行处理。手术时间、术中出血、首次排气排便时间、首次进食时间、住院时间等计量资料比较用t检验;术后并发症、再手术率发生率等资料用χ^2检验,P〈0.05差异具有统计学意义。结果预防性造口组术后首次排气、排便时间为（2.8±0.6）d,未施行预防性造口组为（4.1±0.5）d,差异有统计学意义（t=1.92,P〈0.05）;术后首次进食时间分别为（3.8±1.2）和（5.6±1.8）d;术后平均住院时间分别为（8±2）d和（12±2）d,差异均有统计学意义（t=2.34,t=2.68,P〈0.05）。术后总并发症预防性造口组为1/19（5.3%）,未施行预防性造口组为4/18（22.2%）,两组术后总的并发症发生率差异有统计学意义（χ^2=4.75,P〈0.05）。预防性造口组发生1例（5.3%）吻合口漏,经反复腹腔冲洗引流等保守治疗后痊愈;未造口组发生3例（16.7%）吻合口漏,其中2例经保守治疗后愈合,1例发展为弥漫性腹膜炎接受再手术;经检验,两组吻合口漏发生率有显著统计学差异。两组术后均无因吻合口漏而死亡的病例。结论预防性造口能显著降低吻合口漏的发生率,同时也能降低与吻合口吻合口漏相关的再手术率。对吻合口高度较低及具有高危因素的患者,建议常规施行预防性造口。Objective To investigate the clinical value of defunctioning stoma in patients who underwent sphincter-preserving procedure for low rectal cancer resection. Methods The clinical data of37 patients who underwent sphincter-preserving procedure for low rectal cancer resection from March 2010 to October 2013 in our hospital were analyzed retrospectively. The patients were diagnosed with low rectal cancer pathologically before the operation. The lower edge of carcinoma was less than 7 cm from the anal verge. The 37 patients were divided into a preventive colostomy group（ 19 patients） and a no preventive colostomy group（ 18）. SPSS17. 0 was applied for relative data analysis. Operating time,intraoperating blood loss,first exhaust defecation,first eating,and hospitalization were measured using Student＇s t test.Postoperative complications,reoperation and others were measured by the Chi-square test. P 〈 0. 05 was considered statistically significant. Results The first exhaust and defecation in the preventive colostomy group and the no preventive colostomy group were（ 2. 8 ± 0. 6） d and（ 4. 1 ± 0. 5） d respectively. P value showed significant difference between the two groups（ t = 1. 92,P 〈 0. 05）. The firs eating in the preventive colostomy group（ 3. 8 ± 1. 2） d was earlier than that of the no preventive colostomy group（ 5. 6 ± 1. 8） d（ t = 2. 34,P 〈 0. 05）. Similar results were obtained in hospitalization between the two groups（ 8 ± 2） d and（ 12 ± 2） d,t = 2. 68,P 〈 0. 05）. The total incidences of postoperative complications in the preventivecolostomy group and the no preventive colostomy group were 1 /19（ 5. 3%） and 4 /18（ 22. 2%）,respectively. There was significant difference between the two groups. χ~2= 4. 75,P 〈 0. 05）. Anastomotic leakage occurred in one（ 5. 3%） patient with a preventive stoma and in 3（ 16. 7%） patients without a preventive stoma（ P 〈 0. 05）. Leakage subsided after conservative treatment in the patient with a stoma,b

关 键 词：直肠肿瘤 肠造口术 对比研究 

分 类 号：R735.37[医药卫生—肿瘤]