预防性回肠末端造口术对腹腔镜低位直肠癌根治性保肛手术疗效的影响  

Effect of prophylactic ileostomy on laparoscopic radical sphincter preserving surgery for low rectal cancer

作　　者：蔡彬 周廷亮 蒋笃均[1] 张跃[1] Cai Bin;Zhou Tingliang;Jiang Dujun;Zhang Yue(Department of Gastrointestinal Surgery, XuzhouCancer Hospital, Xuzhou 221002, China)

机构地区：[1]徐州市肿瘤医院胃肠外科

出　　处：《中华普通外科学文献（电子版）》2019年第5期372-376,共5页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的探讨预防性回肠末端造口术对腹腔镜低位直肠癌根治性保肛手术患者炎性指标与前白蛋白及肛门功能的影响。方法选取2010年9月至2012年6月在徐州市肿瘤医院接受治疗的腹腔镜低位直肠癌根治性保肛手术患者96例,随机分为对照组(常规方式吻合)与观察组(预防性回肠末端造口),各48例。比较两组患者围手术期指标,记录两组患者术后0.5~12个月肛门功能情况以及并发症,生存情况采用Kaplan-Meier法和Log-rank检验。结果术后5 d时,观察组患者前白蛋白水平较术前及同期对照组水平升高,C反应蛋白(CRP)、白细胞计数(WBC)较术前及同期对照组水平降低,差异均有统计学意义(t=9.236、8.335、9.164,均P<0.05)。观察组患者的肛管静息压、肛管最大收缩压以及直肠最大耐受容量在术后6、9、12个月时均高于同期对照组,差异有统计学意义(均P<0.05)。观察组患者术后首次肛门排气时间、排便恢复时间、住院时间及并发症发生率均低于对照组,差异有统计学意义(t=6.323、5.913、6.135,χ^2=7.529,均P<0.05)。两组5年生存率、无进展生存时间、平均生存时间比较,差异无统计学意义(χ^2=0.349,t=2.475、1.616;P=0.560、0.450、0.329)。结论预防性回肠末端造口术可降低腹腔镜低位直肠癌根治性保肛手术患者的炎性反应,明显改善患者肛门功能。Objective To investigate the effect of prophylactic ileostomy on inflammatory indexes, prealbumin and anal function in patients undergoing laparoscopic radical anus-preserving surgery for low rectal cancer. Methods Ninety-six patients with laparoscopic low rectal cancer radical anal sphincter surgery who were treated in Xuzhou Cancer Hospital from September 2010 to June 2012 were randomly divided into control group(conventional method) and observation group(preventive ileu-endostomy), with 48 cases in each group. The perioperative indicators were compared. The effects of anal function between 0.5-12 months after surgery and complications were recorded, and survival rate by Kaplan-Meier method and Log-rank test. Results Compared with the control group, the levels of prealbumin in the observation group increased, and CRP and WBC decreased at the 5 th day after operation(t=9.236, 8.335, 9.164, all P<0.05). The resting anal pressure, maximal anal systolic pressure and maximal rectal tolerance volume in the observation group were significantly higher than those in the control group at 6, 9 and 12 months after operation(P<0.05). The first anal exhaust time, defecation recovery time, hospitalization time and incidence of complications in the observation group were less than those in the control group(t=6.323, 5.913, 6.135,χ^2=7.529, all P<0.05). There were no significant differences in 5-year survival rates, progression-free survival time and mean survival time between the two groups(χ^2=0.349, P=0.560;t=2.475, 1.616, P=0.450, 0.329). Conclusion Prophylactic distal ileostomy can reduce the inflammatory reaction in patients with laparoscopic low rectal cancer with radical sphincter preserving surgery and significantly improve the anal function of patients.

关 键 词：回肠造口术 直肠肿瘤 腹腔镜 保肛手术 

分 类 号：R735.37[医药卫生—肿瘤]