末端回肠造瘘术在老年中低位直肠癌患者手术中的应用研究  

Application of terminal ileostomy in the surgery in elderly patients with middle and low rectal cancer

作　　者：刘业六[1] 闫冬升 刘卫东[1] 黄建军 LIU Ye-liu;YAN Dong-sheng;LIU Wei-dong;HUANG Jian-jun(Department of General Surgery,Huai'an First Hospital Affiliated to Nanjing Medical University,Huai'an 223300,China;Department of General surgery,Huai'an First Hospital First Branch Affiliated to Nanjing Medical University,Huai'an 223001,China)

机构地区：[1]南京医科大学附属淮安第一医院普外科,淮安223300 [2]南京医科大学附属淮安第一医院一分院普外科,淮安223001

出　　处：《中国肿瘤临床与康复》2020年第10期1181-1184,共4页Chinese Journal of Clinical Oncology and Rehabilitation

基　　金：南京医科大学科技发展基金重点项目(2017NJMUZD087)。

摘　　要：目的探讨末端回肠造瘘术在中低位老年直肠癌保肛根治术中的应用效果。方法选取2017年1月至2019年9月间南京医科大学附属淮安第一医院收治的92例行腹腔镜直肠癌保肛根治术治疗的中低位老年直肠癌患者,采用随机数字表法分为观察组和对照组,每组46例。对照组患者采用腹腔镜直肠癌保肛根治术,观察组患者采用腹腔镜直肠癌保肛根治术+末端回肠造瘘术,比较两组患者手术相关指标、术后营养状况和手术并发症情况。结果两组患者手术时间和术中出血量比较,差异无统计学意义(P>0.05)。观察组患者术后首次进食时间、术后拔引流管时间和术后住院时间均短于对照组,差异均有统计学意义(均P<0.05)。两组患者手术前后白蛋白和总蛋白营养情况比较,差异均无统计学意义(P>0.05)。但观察组患者术后静脉补充白蛋白量低于对照组,差异有统计学意义(P<0.05)。两组患者并发症总发生率比较,差异无统计学意义(P>0.05)。观察组患者吻合口瘘发生率低于对照组,肠梗阻发生率高于对照组,差异均有统计学意义(均P<0.05)。结论老年直肠癌且行保肛根治术患者应用末端回肠造瘘术,可缩短患者术后康复时间,减少术后吻合口瘘及其严重临床症状,治疗效果较好。Objective To study the efficacy of terminal ilealostomy in the laparoscopic anus-conserving radical resection in the treatment of elderly patients with middle and lower rectal cancer.Methods A total of 92 elderly patients with middle and low rectal cancer who underwent laparoscopic rectal cancer anusconserving radical resection between January 2017 and September 2019 were selected.They were divided into an observation group and a control group by digital random method with 46 patients in each group.The observation group underwent laparoscopic anus-conserving radical resection combined with terminal ileostomy and the control group cases underwent laparoscopic anus-conserving radical resection alone.The surgical indicators,postoperative nutritional status and complications were compared between the two groups.Results There was no significant difference in operation duration and intraoperative blood loss between the two groups(P>0.05).The postoperative feeding time,time to extubation and drainage,and length of hospital stay was shorter in the observation group than the control group(all P<0.05).There was no significant difference in albumin and total protein between the two groups before and after the surgery(P>0.05).The postoperative intravenous albumin supplementation was lower in the observation group than the control group(P<0.05).No significant difference in incidence of postoperative complications was observed between the two groups(P>0.05).The incidence of anastomotic fistula was lower in the observation group than in the control group(P<0.05),but the incidence of postoperative intestinal obstruction was higher in the observation group than in the control group(P<0.05).Conclusion Terminal ileostomy can shorten the postoperative recovery time,reduce the occurrence of postoperative anastomotic fistula and severe clinical symptoms in elderly rectal cancer patients undergoing laparoscopic anus-conserving radical resection with good efficacy.

关 键 词：直肠肿瘤 末端回肠造瘘术 保肛根治术 腹腔镜 

分 类 号：R735.3[医药卫生—肿瘤]