皮桥袢式回肠造口在腹腔镜低位直肠前切除术中应用价值研究  

Study on the application value of skin bridge loop ileostomy in laparoscopic low anterior resection of the rectum

作　　者：陆威 叶辉[1] 龚治林[1] 于杰[1] 周启昌[1] 黄淑娟 郗昌磊 曹龙磊 王沛云 李昊平 沈洁 LU Wei;YE Hui;GONG Zhi-lin(Department of Colorectal Anal Surgery,Jingzhou Hospital,Yangtze University,Jingzhou 434020,China)

机构地区：[1]长江大学附属荆州医院结直肠肛门外科,湖北荆州434020

出　　处：《中国实用外科杂志》2021年第8期919-923,共5页Chinese Journal of Practical Surgery

基　　金：湖北省自然科学基金(No.2018CFC834);湖北省卫生健康委项目(No.WJ2018H211);荆州市科技计划指令性项目(No.2019CC54-05)。

摘　　要：目的探讨皮桥袢式回肠造口方法在腹腔镜低位直肠前切除术中的应用价值。方法回顾性分析2015年1月至2019年6月在长江大学附属荆州医院结直肠肛门外科因低位直肠癌行腹腔镜低位直肠前切除术联合回肠造口80例病人资料。根据回肠造口方式不同分为皮桥袢式回肠造口组(40例)和传统袢式回肠造口组(40例)。比较两组病人术后造口相关并发症及满意度的差异。结果皮桥袢式回肠造口组和传统袢式回肠造口组病人比较,基本资料差异均无统计学意义(P>0.05),手术操作时间、造口旁疝及造口处伤口感染发生率差异无统计学意义[(21.1±3.3)min vs.(21.2±3.8)min,15.0%(6/40)vs.17.5%(7/40),0(0/40)vs.2.5%(1/40),P均>0.05];皮桥袢式回肠造口组在术后VAS评分、DET评分及皮肤黏膜分离发生率均较传统袢式回肠造口组下降[(0.8±0.7)vs.(2.5±1.4),(1.8±1.5)vs.(6.4±3.6),2.5%(1/40)vs.62.5%(25/40),P均<0.05];两组病人术后均未出现造口脱垂、造口回缩、造口狭窄;护士及病人对造口满意度评分调查比较,皮桥袢式回肠造口组均高于传统袢式回肠造口组[(2.9±0.3)vs.(2.6±0.5),(2.4±0.7)vs.(2.0±0.7),P均<0.05]。结论皮桥袢式回肠造口在腹腔镜低位直肠前切除术中较传统袢式回肠造口更具优势,可显著减少术后造口相关并发症及增加护士、病人满意度。Objective To explore the application value of skin bridge loop ileostomy in laparoscopic low anterior resection of the rectum.Methods A total of 80 patients with rectal cancer who underwent laparoscopic low anterior resection and loop ileostomy were retrospectively collected between January 2015 to June 2019 at the Department of Colorectal Anal Surgery,Jingzhou Hospital,Yangtze University.According to the different ileostomy methods,they were divided into skin bridge loop ileostomy group(n=40) and traditional loop ileostomy group(n=40).The differences of postoperative ostomy-related complications and satisfaction were compared between the two groups.Results There were no significant difference(P>0.05) in the basic data,the surgical operation time [(21.1±3.3 min) vs.(21.2±3.8 min),P> 0.05],the incidence of parastomal hernias [15%(6/40) vs.17.5%(7/40),P>0.05] and the wound infections [0(0/40) vs.2.5%(1/40),P>0.05] between the two groups.Postoperative VAS and DET scores and the incidence of mucocutaneous separation in the skin bridge loop ileostomy group were lower than that of traditional loop ileostomy group[(0.8±0.7) vs.(2.5±1.4),P<0.05;(1.8±1.5) vs.(6.4±3.6),P <0.05;2.5%(1/40) vs.62.5%(25/40),P<0.05].Stoma prolapse,retraction and stenosis hadn’t been seen in both groups.The satisfaction of nurses and patients were better in the skin bridge loop ileostomy group than that of traditional loop ileostomy group [(2.9±0.3) vs.(2.6±0.5),P<0.05;(2.4±0.7) vs.(2.0±0.7),P<0.05].Conclusion The skin bridge loop ileostomy was superior to the traditional loop ileostomy in laparoscopic low anterior resection of the rectum.It could significantly decrease the postoperative ostomy-related complications and increase the satisfaction of nurses and patients.

关 键 词：肠造口 腹腔镜 直肠前切除术 直肠癌 

分 类 号：R6[医药卫生—外科学]