预防性回肠末端造口在腹腔镜直肠癌根治术中的应用价值  

Application value of prophylactic terminal ileum enterostomy in laparoscopic radical resection of rectal cancer

作　　者：李伟[1] 宋巍巍[1] 张学峰[1] 郭锋满 陈壮浩[1] 陈海生[1] LI Wei;SONG Weiwei;ZHANG Xuefeng;GUO Fengman;CHEN Zhuanghao;CHEN Haisheng(Department of General Surgery,Zhongshan Municipal Hospital of Traditional Chinese Medicine,Zhongshan,Guangdong 528400,China)

机构地区：[1]广东省中山市中医院普外科

出　　处：《重庆医学》2019年第11期1882-1886,共5页Chongqing medicine

摘　　要：目的探讨预防性回肠末端造口在腹腔镜直肠癌根治术中的应用价值。方法收集该院2014年1月至2018年6月收治的直肠癌病例,将其分为造口组(n=128)和非造口组(n=126),造口组患者术后3个月返院行造口回纳术。术后随访6个月,收集相关临床资料并进行统计学分析。结果两组患者临床基线资料、术中出血量差异无统计学意义(P=0.77);造口组与非造口组比较除手术时间较长(181±26)minvs.(169±22)min,P<0.01:外,患者术后排气/便时间(1.6±0.8)dvs.(2.0±0.9)d,P=0.001:、首次进食时间(1.7±0.7)dvs.(2.1±0.9)d,P=0.003:及术后住院时间(9.5±1.7)dvs.(11.5±3.4)d,P<0.01:明显缩短。两组病例术后吻合口漏发生率差异无统计学意义(10.2%vs.14.3%,P=0.32),但造口组吻合口漏严重程度明显低于非造口组(P=0.036)。在肠梗阻、腹腔出血、腹部感染、切口感染及吻合口狭窄并发症发生率方面两组差异无统计学意义。多因素Logistic回归分析显示术前放疗(OR5.05,95%CI2.24~11.40,P<0.01)和吻合口高度(OR3.53,95%CI1.46~8.50,P=0.005)是术后发生吻合口漏的独立危险因素。结论预防性回肠末端造口不能显著降低腹腔镜直肠癌根治术后吻合口漏发生率,在临床上应充分权衡预防性造口的利弊,不建议常规应用。Objective To investigate the application value of prophylactic terminal ileum enterostomy in laparoscopic radical resection of rectal cancer. Methods The cases of rectal cancer diagnosed in this hospital from January 2014 to June 2018 were collected and divided into the stoma group(n=128) and non-stoma group(n=126).The patients in the stoma group returned to the hospital for conducting the colostomy closure at postoperative 3 months.The relevant clinical data were collected and statistical analysis was performed subsequently after 6 months of follow-up. Results The clinical baseline data and intra-operative bleeding volume had no statistical difference between the two groups( P =0.77).the operation time in the stoma group was significantly longer than that in the non-stoma group(181±26)min vs.(169±22) min, P <0.01:,the postoperative exhaust /defecation time (1.6±0.8) d vs.(2.0±0.9) d, P =0.001:,first eating time(1.7±0.7)d vs.(2.1±0.9) d, P =0.003: and postoperative hospitalization time (9.5±1.7)d vs.(11.5±3.4) d, P <0.01: in the stoma group were significantly decreased compared with the non-stoma group.The incidence rate of postoperative anastomotic leakage had no statistical difference between the two groups (10.2% vs. 14.3%, P = 0.32),but the severity degree of anastomotic leak in the stoma group was significantly lower than that in the non-stoma group ( P =0.036).No statistically significant differences were found in the aspects of the incidence of intestinal obstruction,intra-abdominal hemorrhage,abdominal infection,wound infection and anastomotic stenosis between the two groups.The multivariate Logistic regression analysis showed that preoperative radiotherapy ( OR 5.05,95% CI 2.24-11.40, P <0.01) and anastomotic height ( OR 3.53,95% CI 1.46- 8.50 , P =0.005) were the independent risk factors for postoperative anastomotic leakage. Conclusion The prophylactic terminal ileum enterostomy can not decrease the occurrence rate of anastomotic leakage of laparoscopic radical resection of rectal cancer,theref

关 键 词：回肠造口 腹腔镜直肠癌根治术 吻合口漏 术后并发症 

分 类 号：R735.3[医药卫生—肿瘤]