不同造口术对低位直肠癌腹腔镜保肛手术患者预后的影响  

Effects of Different Ostomy Methods on Prognosis of Patients with Laparoscopic Anuspreserving Surgery for Low Rectal Cancer

作　　者：肖燕玲[1] 肖琴 张菊[1] 税方 何谦[1] XIAO Yanling;XIAO Qin;ZHANG Ju(Suining Central Hospital,Suining,629000)

机构地区：[1]四川省遂宁市中心医院,629000 [2]四川省遂宁市中医院社区医院,629000

出　　处：《实用癌症杂志》2020年第8期1302-1305,共4页The Practical Journal of Cancer

摘　　要：目的探讨不同造口术对低位直肠癌腹腔镜保肛手术患者预后的影响。方法回顾性分析114例低位直肠癌腹腔镜保肛并预防性造口手术患者全部临床资料,其中行预防性末端回肠造口术为A组(n=50),行预防性横结肠造口术为B组(n=64),比较2组造瘘术后相关指标、还瘘术后相关指标、肛门功能恢复情况以及生活质量的变化情况。结果造瘘术后,A组第一次排便时间、出院时间显著短于B组,差异有统计学意义(P<0.05);2组造口回缩、皮肤过敏、造口狭窄、造口疝发生率比较,差异无统计学意义(P>0.05)。A组造口脱垂发生率为2.00%,B组造口脱垂发生率为15.63%,2组比较差异有统计学意义(P<0.05)。还瘘术后,A组第一次排便时间、出院时间显著短于B组,差异有统计学意义(P<0.05);2组吻合口瘘、吻合口狭窄发生率比较,差异无统计学意义(P>0.05)。A组切口感染发生率为6.00%,B组切口感染发生率为20.31%,2组差异有统计学意义(P<0.05)。术后6个月、12个月2组Wexner评分逐渐降低(P<0.05),且A组术后12个月Wexner评分显著低于B组(P<0.05);术后6个月、12个月2组QLQ-C30评分逐渐升高(P<0.05),且A组术后6个月、12个月QLQ-C30评分显著高于B组(P<0.05)。结论与预防性横结肠造口术比较,预防性末端回肠造口术对进行腹腔镜保肛手术的低位直肠癌患者效果更好,其第一次排便时间、出院时间更短,造瘘术后造口脱垂发生率更低,还瘘术后切口感染发生率更低,术后肛门功能恢复情况更优,生活质量更高,患者远期预后更好。Objective To explore the effects of different ostomy methods on the prognosis of patients with laparoscopic anus-preserving surgery for low rectal cancer.Methods A retrospective analysis was performed on all clinical data of 114 patients who underwent laparoscopic anus-preserving surgery and prophylactic ostomy for low rectal cancer.The patients with prophylactic terminal ileostomy were set as group A(n=50),and the patients with prophylactic transverse colostomy were set as group B(n=64).The relative indexes after ostomy,relative indexes after return of ostomy bag,recovery of anal function and quality of life were compared between the two groups.Results After ostomy,the first defecation time and discharge time in group A were significantly shorter than those in group B(P<0.05).There were no significant differences in the incidence rates of stoma retraction,skin allergy,stoma stenosis and ostomy hernia between the 2 groups(P>0.05).The incidence rate of ostomy prolapse was 2%in group A and 15.63%in group B(P<0.05).After return of ostomy bag,the first defecation time and discharge time in group A were significantly shorter than those in group B(P<0.05).There were no significant differences in the incidence rates of f anastomotic leakage and anastomotic stenosis between the 2 groups(P>0.05).The incidence rate of incision infection was 6%in group A and 20.31%in group B(P<0.05).At 6 months after surgery and at 12 months after surgery,the Wexner scores in the two groups were significantly decreased in turn(P<0.05),and the Wexner score at 12 months after surgery in group A was significantly lower than that in group B(P<0.05).At 6 months after surgery and at 12 months after surgery,the QLQ-C30 scores in the 2 groups were significantly increased(P<0.05),and the scores of QLQ-C30 at 6 months and 12 months after surgery in group A were significantly higher than those in group B(P<0.05).Conclusion Compared with prophylactic transverse colostomy,prophylactic terminal ileostomy is more effective in patients with laparoscopic an

关 键 词：预防性横结肠造口 预防性末端回肠造口 低位直肠癌 腹腔镜保肛手术 预后 

分 类 号：R735.37[医药卫生—肿瘤]