预防性皮瓣支撑末端回肠造口术在腹腔镜低位直肠癌根治术中的应用  

Application of preventive flap-placement of terminal ileostomy in laparoscopic radical resection of low rectal cancer

作　　者：牛晋卫[1] 宁武[1] 周雷[1] 裴东坡孟凡强 刘质泽[1] Niu Jinwei;Ning Wu;Zhou Lei;Pei Dongpo;Meng Fanqiang(Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China)

机构地区：[1]中日友好医院普通外科,北京100029

出　　处：《中华医学杂志》2019年第10期750-753,共4页National Medical Journal of China

摘　　要：目的评价预防性皮瓣支撑末端回肠造口术在腹腔镜低位直肠癌根治术中的应用价值。方法回顾性分析中日友好医院普通外科一部2016年4月至2018年3月行预防性回肠造口的63例低位直肠癌患者的临床资料,其中皮瓣支撑造口组(皮瓣组)33例,传统支架管造口组(置管组)30例,分析比较两组患者的临床资料。结果两组患者均顺利完成腹腔镜下直肠癌根治术加预防性回肠末端造口术。置管组术后1个月均完成支架管拆除。两组根治术后吻合口漏发生率,还纳手术时间及造口并发症各项发生率,差异均无统计学意义(均P>0.05)。但皮瓣组比置管组造口手术时间短[(28.9±4.3)min比(36.3±2.3)min,t=11.73,P<0.001],皮瓣组造口总并发症发生率低于置管组(1例比7例,χ2=4.155,P=0.042),差异均有统计学意义。结论对有吻合口漏高危因素的低位直肠癌患者,预防性皮瓣支撑造口术操作简单、快捷,免于拆除支架管,造口相关并发症发生率低,是一种理想的可供选择的方法,可予以推广。Objective To evaluate the value of preventive flap placement of terminal ileostomy in laparoscopic radical resection of low rectal cancer. Methods A retrospective analysis was conducted in the patients (n=63) who received preventive terminal ileostomy in laparoscopic radical resection of low rectal cancer in our institution from April 2016 to March 2018, including 33 patients who underwent ileostomy with flap-placement (flap group), and 30 patients who underwent ileostomy with stent (stent group). Clinical data were collected from both groups and statistically analyzed. Results All patients were successfully completed laparoscopic radical resection with preventive ileostomy. All patients of stent group received stoma-closure surgery one month later after rectal resection. There were significantly statistical differences in operating time of ileostomy (28.9±4.3 vs 36.3±2.3, t=11.73, P<0.001) and overall stoma-related complications (1 vs 7,χ2=4.155, P=0.042), but no difference in anastomosis leakage, operating time of stoma-reversal, parastomal infection, parastomal hernia and parastomal prolapse. Conclusions Preventive flap placement of terminal ileostomy represents a secure and feasible approach to laparoscopic low rectal cancer resection. Patients can be released from the discomfort of removing the stent and may suffer fewer stoma-related complications.

关 键 词：直肠肿瘤 回肠造口术 外科皮瓣 

分 类 号：R735.37[医药卫生—肿瘤]