使用下腹部陈旧手术切口做直肠癌标本取出和预防性造口的可行性研究  

The feasibility study of specimen removing and dysfunctional loop ileostomy using previous lower abdominal incision for patients with rectal cancer

作　　者：崔伟[1] 张玉瑾 孙亮 魏小军 李世拥 Cui Wei;Zhang Yujin;Sun Liang;Wei Xiaojun;Li Shiyong(Department of General Surgery,the Seventh Medical Center of PLA General Hospital,Beijing 100700,China;Department of Obstetrics and Gynecology,the Seventh Medical Center of PLA General Hospital,Beijing 100700,China)

机构地区：[1]解放军总医院第七医学中心普通外科,北京100700 [2]解放军总医院第七医学中心妇产科,北京100700

出　　处：《中华结直肠疾病电子杂志》2020年第4期387-390,共4页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：解放军军队后勤科研项目(No.CLJ17J022)。

摘　　要：目的探讨使用下腹部陈旧手术切口做直肠癌标本取出和预防性造口的可行性。方法回顾性分析解放军总医院第七医学中心普通外科2017年1月~2019年6月间收治的中低位直肠癌腹腔镜保肛手术后行末端回肠双腔造口的患者的临床资料,其中22例应用了既往下腹部及盆腔脏器手术切口取出标本和预防性造口(观察组);选取同期情况相近的经左侧腹直肌切口取标本,经右下腹行预防性造口的直肠癌患者40例作为对照组。比较两组患者的一般资料和造口及造口还纳相关并发症的发生情况,疼痛情况采用视觉模拟评分法(VAS)比较,出院时采用功能状态(Karnofsky)评分评价患者功能状态。结果两组患者手术时间、术中出血量、术后进食时间、造口袋首次渗漏时间、结直肠吻合口漏发生率相比较差异均无统计学意义(t=2.539、0.879、0.866、0.774,χ^2=6.508;P>0.05)。观察组术后各时间点患者疼痛情况评分分值均显著低于对照组(t=5.695,7.614,6.677;P<0.05),术后使用镇痛药物人次显著下降(χ^2=5.213,P<0.05)。两组患者造口相关并发症发生率、造口还纳相关并发症的发生率相比较差异均无统计学意义(P>0.05)。观察组Karnofsky功能状态评分为(83.7±5.6)分,显著高于对照组(78.4±5.2)分(t=2.906,P<0.05)。结论对于中低位直肠癌保肛手术后行末端回肠双腔造口的患者,使用下腹部陈旧手术切口做标本取出和预防性造口是安全可行的,患者术后恢复较快,值得临床应用。Objective To study the feasibility of specimen removing and dysfunctional loop ileostomy using previous lower abdominal incision for patients with rectal cancer.Methods The 22 cases of rectal cancer that received sphincter-saving surgery and dysfunctional loop ileostomy using previous lower abdominal incision treated in our hospital from Jan 2017 to Jun 2019 were analyzed,which was regard as observation group.The 40 cases which had used a new incision were selected as control group.The clinical data and complication with stoma and closure of stoma were collected and analyzed.The VAS score was used to compare the pain severity.The Karnofsky score was used to compare the functional status.Results No significant difference was noted between the two groups in terms of operative time,blood loss,postoperative eating time,first leaked time of stoma bag,incidence of anastomotic leakage(t=2.539,0.879,0.866,0.774,χ^2=6.508;P>0.05).The scores of pain severity in the observation group were significantly lower than those in the control group at every time after the operation(t=5.695,7.614,6.677;P<0.05).The cases of using analgesic were also lower than the control group(χ^2=5.213,P<0.05).There were no significant differences between the two groups in the incidence of complications related to stoma and stoma closure(P>0.05).The Karnofsky score was(82.7±5.6)in the observation group,which was significant higher than(78.4±5.2)in control group(t=2.906,P<0.05).Conclusions It is safe and feasible to do specimen removing and dysfunctional loop ileostomy using previous lower abdominal incision for patients with rectal cancer,which promote the recovery.

关 键 词：直肠肿瘤 陈旧切口 末端回肠双腔造口 保肛手术 

分 类 号：R735.37[医药卫生—肿瘤]