应用吻合环复合装置对直肠癌手术行保护性回肠造口的临床研究  

Clinical application of compound anastomotic device in protective terminal ileostomy duringrectal cancer operation

作　　者：黄琦[1] 曹烽 周金哲 刘黎明[1] 葛步军[1] 

机构地区：[1]上海同济大学附属同济医院胃肠外科,200065 [2]江西省景德镇市第三人民医院胃肠外科333001

出　　处：《中华胃肠外科杂志》2017年第12期1375-1380,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81370586）;上海市科委引导类项目（15411962600）

摘　　要：目的探讨应用自制“吻合环复合装置”行保护性回肠造口术在直肠癌术中对保护直肠高危吻合口的临床效果。方法前瞻性研究2011年5月至2016年10月期间，上海同济大学附属同济医院胃肠外科及医疗联合体集团医院（江西省景德镇市第三人民医院）手术治疗并附加保护性回肠造口的116例成年直肠癌患者（同济医院90例，景德镇市第三人民医院26例），应用平行对照研究方案和随机数字表法分组，进行吻合环复合装置保护性回肠造口（吻合环组，58例）与传统末端回肠造口术（传统造口组，58例）的对比研究。吻合环复合装置由可降解的Valtrac生物可降解吻合环、引流管和避孕套等组合而成。在完成腹腔镜全直肠系膜切除术后，腹腔镜下经切口游离出回盲部；制作两个肠管环形荷包，并在荷包问切开肠壁置入吻合环复合装置：收紧荷包，闭合吻合环，包埋并将吻合环复合装置从右下腹Trocar孔引出腹腔外，腹壁外缝合固定引流管，接引流袋或外罩造口袋，完成经回肠吻合环复合装置保护性造口术。比较两组吻合口瘘的发生率及转归，附加手术的相关并发症以及总住院天数、总费用支出。结果两组患者一般临床资料的比较差异无统计学意义（P〉0．05）。两组患者均顺利完成造口手术。吻合环组造口手术操作时间为（34．6±13．8）min，传统造口组手术操作时间为（25．8±14．0）min，差异有统计学意义（t=2．123，P=0．035）。术后共发生吻合口瘘7例，其中常规造口组3例，均症状轻微；吻合环组4例，1例再次手术切除坏死肠段后左下腹结肠造口。两组吻合口瘘发生率差异无统计学意义（P〉0．05）。吻合环组共有17例（29．3％）发生造口相关并发症，低于传统造口组（35／58，60．3％；x2=3．216，P=0．002）。116例患者均于术后7～37d出院。吻合环组住院Objective To investigate the clinical effect of the application of ＂compound anastomotic device＂ on the high-risk colorectal anastomosis in rectal cancer patients undergoing protective ileostomy. Methods A total of 116 rectal cancer patients undergoing surgical procedure andprophylactic ileostomy in Tongji Hospital （90 cases） and The Third People＇s Hospital of Jingdezhen City （26 cases） from May 2011 to October 2016 were prospectively enrolled in the study. Paralleled control study and random digital table were applied. Fifty-eight cases received the compound anastomotic device for protective ileostomy （anastomosis iing group） and 58 cases underwent traditional terminal ileostomy （traditional group）. The compound device was mainly composed of Valtrac biodegradable anastomosis ring, drainage tube and condom. Operational procedure was as follows： Ileocecum was freed through incision following laparoscopic total mesorectal excision; Two intestinal ring-shape purses were made; Intestinal wall between purse string was cut and the compound anastomotic device was put into; The purse was tightened and anastomosis ring was closed; The compound device was embed and pull out through the Trocar hole in the right lower abdomen; Then the drainage tube was fixed to the abdominal wall and connected with a drainage bag or an outer pocket. Incidence of anastomotic leak, stoma- related complications, hospital stay and total cost of two groups were compared. Results The general clinical data between two groups were not significantly different （all P 〉 0.05）. Stoma operation was performed successfully in all the patients of two groups. The stoma operation time was （34.6 ± 13.8） min in anastomosis ring group and （25.8 ± 14.0） rain in traditional group with significant difference （t=2.123, P= 0.035）. Postoperative anastomotic leak occurred in 7 cases, including 3 cases with small fistula in traditional group and 4 cases in anastomosis ring group, of whom 1 case underwent left-low abdominal co

关 键 词：直肠肿瘤 外科手术 吻合口瘘 吻合环 保护性末段回肠造口术 

分 类 号：R735.37[医药卫生—肿瘤]