纵切式末端回肠襻式造瘘在腹腔镜低位直肠癌前切除术中的应用  

Application of Longitudinal End-Stage Ileal Fistula in Laparoscopic Low Rectal Cancer Anterior Resection

作　　者：肖荷芳[1] 陈子文[1] 刘红权[1] 方传发[1] 刘传渊[1] 赖承治[1] 钟武[1] XIAO Hefang;CHEN Ziwen;LIU Hongquan;FANGChuanfa;LIU Chuanyuan;LAI Chengzhi;ZHONG Wu(Ganzhou People's Hospital,Ganzhou 341000,China)

机构地区：[1]赣州市人民医院,江西赣州341000

出　　处：《现代医院》2018年第12期1812-1814,共3页Modern Hospitals

基　　金：赣州市科技局指导性科技计划项目(GZ 2017ZSF203)

摘　　要：目的评价纵切式末端回肠襻式造瘘在腹腔镜低位直肠癌前切除术中的应用价值。方法回顾性分析2016年1月—2018年6月因低位直肠癌行腹腔镜直肠全系膜切除保肛术116例患者的临床资料,分为观察组62例和对照组54例,对照组行腹腔镜低位直肠癌前切除术,观察组直肠癌腹腔镜前切除术手术操作同对照组患者,在完成结直肠吻合后,加行纵切式回肠襻式造瘘;观察两组吻合口瘘的发生情况以及术后首次排气时间、进食时间、骶前引流管拔除时间、术后住院时间等指标。结果观察组吻合口瘘发生率13. 0%(8例),发生吻合口瘘的患者症状较轻,行骶前引流管低压冲洗引流后愈合;术后肛门首次排气时间(1. 4±0. 5) d,进食时间(1. 2±0. 3) d,骶前引流管拔除时间(5. 8±0. 9) d,术后住院时间(7. 6±1. 5) d。对照组患者术后吻合口瘘发生率11%(6例),发生吻合口瘘患者的症状较重,其中4例行骶前引流管冲洗引流及药物坐浴经较长时间治愈,2例全身症状严重行非计划再手术;术后肛门首次排气时间(2. 8±0. 9) d,进食时间(2. 3±0. 6) d,骶前引流管拔除时间(7. 3±1. 4) d,术后住院时间(9. 7±3. 5) d。两组术后观察指标吻合口瘘发生率无差异,首次排气时间、进食时间、骶前引流管拔除时间、术后住院时间比较差异均有统计学意义(P <0. 05)。结论纵切式末端回肠襻式造瘘没有显著降低低位直肠癌前切除术后吻合口瘘的发生率,但术后首次排气时间、进食时间、骶前引流管拔除时间明显提前,可显著缩短住院时间,值得临床推广。Ojbective To evaluate the value of longitudinal ileal fistula in the treatment of laparoscopic low rectal anterior resection.Methods Retrospective analysis of116patients with low rectal cancer undergoing laparoscopic total mesorectal excision and anal sphincter preservation from January2016to June2018,divided into observation group of62cases and control group of54cases,the control group underwent abdominal cavity Mirror anterior resection of rectal cancer,observation group laparoscopic laparoscopic surgery with the control group,after the completion of colorectal anastomosis,plus longitudinal ileal fistula;observed the occurrence of anastomotic leakage The situation and the first time after the operation,the time of eating,the time of extraction of the drainage tube before the sputum,the postoperative hospital stay and other indicators.Results The incidence of anastomotic leakage was13.0%(8cases)in the observation group.The symptoms of patients with anastomotic leakage were mild,and the drainage of the drainage tube was healed after low pressure irrigation.The first anesthesia time of the anus was(1.4±0.5)d,the feeding time was(1.2±0.3)d,the extraction time of the drainage tube was(5.8±0.9)d,and the postoperative hospital stay was(7.6±1.5)d.In the control group,the incidence of postoperative anastomotic leakage was11.0%(6cases).The symptoms of patients with anastomotic leakage were severe.4patients underwent sputum irrigation and drainage and the drug was cured for a long time.2patients with severe systemic symptoms underwent unplanned reoperation.The first anesthesia time of the anus was(2.8±0.9)d,the feeding time was(2.3±0.6)d,the drainage time of the sacral drainage tube was(7.3±1.4)d,and the postoperative hospital stay was(9.7±3.5)d.There were no significant differences in the incidence of anastomotic leakage,the first exhaust time,the feeding time,the extraction time of the anterior tibial drainage tube,and the postoperative hospital stay in the two groups(P<0.05).Conclusion Longitudinal end ileal fi

关 键 词：末端回肠预防性造瘘 低位直肠癌 腹腔镜保肛手术 

分 类 号：R735.3[医药卫生—肿瘤]