预防性回肠造口远端黏膜关闭术对腹腔镜直肠癌根治术后吻合口瘘发生的影响及其相关因素分析  

Effect of Prophylactic Ileostomy Distal Mucosal Closure on Anastomotic Fistula After Laparoscopic Radical Resection of Rectal Cancer and Its Related Factors

作　　者：刘如钱 苏志坚 林周 LIU Ruqian;SU Zhijian;LIN Zhou(The Affiliated Hospital of Jiangnan University,Jiangsu Wuxi 214000,China)

机构地区：[1]江南大学附属医院胃肠外科,江苏无锡214000

出　　处：《河北医学》2021年第9期1496-1500,共5页Hebei Medicine

基　　金：江苏省无锡市科技发展计划项目,(编号:N20191001)。

摘　　要：目的:探究预防性回肠造口远端黏膜关闭术对腹腔镜直肠癌根治术后吻合口瘘发生的影响及其相关因素。方法:回顾性分析本院2019年5月至2020年5月收治的75例直肠癌患者的临床资料,根据其手术方式分为A(39例)、B组(36例),A组在腹腔镜直肠癌根治手术后行预防性回肠造口远端黏膜关闭术,B组行常规腹腔镜直肠癌根治手术,对比两组患者术后住院天数、肠胃功能恢复时间、吻合口瘘愈合时间及术后发生切口感染、肠粘连及吻合口瘘情况;依据术后是否发生吻合口瘘分为吻合口瘘组(10例)与无吻合口瘘组(65例),根据单因素分析结果将有意义的指标纳入Logistic回归。结果:①A组患者术后住院天数、肠胃功能恢复时间及吻合口瘘愈合时间低于B组,P<0.05;②A组患者术后发生切口感染(5.13%)、肠粘连(7.69%)及吻合口瘘(5.13%)概率显著低于B组(19.44%、25.00%、22.22%),P<0.05;③Logistic回归表明肿瘤距肛缘距离为发生吻合口瘘的独立性危险因素,P<0.05。结论:腹腔镜直肠癌根治术后行预防性回肠造口远端黏膜关闭术对直肠癌患者临床疗效显著,能够有效降低吻合口瘘发生概率;肿瘤距肛缘距离为发生吻合口瘘的独立危险因素,临床需多关注并给予患者针对性的护理。Objective:To investigate the effect of prophylactic ileostomy distal mucosal closure on the occurrence of anastomotic fistula after laparoscopic radical resection of rectal cancer and its related factors.Methods:A retrospective analysis of the clinical data of 75 patients with rectal cancer admitted to our hospital from May 2019 to May 2020 was conducted.According to their surgical methods,they were divided into groups A(39 cases)and group B(36 cases).Group A was in laparoscopic rectal cancer.After radical cancer surgery,preventive ileostomy distal mucosal closure was performed.And group B received conventional laparoscopic radical rectal cancer surgery.The length of hospital stay,gastrointestinal function recovery time,anastomotic leakage healing time and postoperative occurrence were compared between the two groups,as well as the incision infection,intestinal adhesions and anastomotic leakage.According to whether an anastomotic leakage occurred after the operation,patients were subgrouped into anastomotic leakage group(10 cases)and non-anastomotic leakage group(65 cases).According to the results of univariate analysis,meaningful indicators were included into Logistic regression.Result:①The postoperative hospital stay,gastrointestinal function recovery time and anastomotic fistula healing time in group A were lower than those in group B,P<0.05;②The incidence of postoperative incision infection(5.13%),intestinal adhesion(7.69%)and anastomotic fistula(5.13%)in group A were significantly lower than those in group B(19.44%,25.00%,22.22%),P<0.05;③Logistic regression showed that distance from tumor to anal margin was an independent risk factor for anastomotic fistula,P<0.05.Conclusion:Prophylaxis of distal mucosal closure of ileostomy after laparoscopic radical resection of rectal cancer has significant clinical effect on patients with rectal cancer,which can effectively reduce the probability of anastomotic fistula.The distance between tumor and anal margin is an independent risk factor for anastomotic fistula,

关 键 词：预防性回肠造口远端黏膜关闭 腹腔镜直肠癌根治术 吻合口瘘 

分 类 号：R735.37[医药卫生—肿瘤]