腹腔镜下腹会阴直肠癌手术中两种乙状结肠造口的临床比较  

Comparative study of two different sigmoidostomy in laparoscopic abdominoperineal resection of rectal cancer

作　　者：李关宁 杨俊杰 杨振淮 Li Guanning;Yang Junjie;Yang Zhenhuai(Department of Surgery,Affiliated TCM Hospital of Guangzhou Medical University,Guangdong 510130,China)

机构地区：[1]广州医科大学附属中医医院外科,510130

出　　处：《中华普外科手术学杂志（电子版）》2021年第5期546-549,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：广东省中医药局科研项目(20162116)。

摘　　要：目的对比腹腔镜下腹会阴直肠癌手术中两种乙状结肠造口的临床效果。方法回顾性队列研究2017年5月至2020年3月在接受腹腔镜下腹会阴直肠癌手术的81例患者临床资料,根据术中乙状结肠造口方式不同分为腹膜外组(经腹膜外造口,36例)、腹膜内组(经腹膜内造口,45例),采用SPSS23.0软件进行处理,围术期指标等以(±s)表示,独立t检验;排便功能、Kirwan失禁分级、术后并发症等用χ^(2)检验或秩和检验,P<0.05为差异有统计学意义。结果腹膜外组手术时间、术后首次排气、排便时间、术后住院时间和术中出血量均少于腹膜内组(P<0.05);腹膜外组术后排便功能总优良率(80.6%)比腹膜内组(60.0%)高(P<0.05)、术后Kirwan失禁分级比腹膜内组轻(P<0.05);腹膜外组术后并发症发生率(8.3%)比腹膜内组(26.7%)低(P<0.05)。结论相比经腹膜内乙状结肠造口,腹腔镜下腹会阴直肠癌手术中经腹膜外造口更利于加快术后康复进程,减少造口并发症,且患者排便、控便能力更好,安全性更高。Objective To compare the clinical outcome of two different sigmoidostomy in laparoscopic abdominoperineal resection(LAPR)of rectal cancer.Methods From May 2017 to March 2020,the clinical data of 81 patients underwent LAPR were analyzed retrospectively,who were divided into the extraperitoneal group(extraperitoneal stoma,36 cases),and the intraperitoneal group(intraperitoneal stoma,45 cases).Statistical analysis were performed by using SPSS23.0 software.The perioperative indicators were expressed as,and were examined by using independent t test.Defecation function,Kirwan incontinence classification for postoperative complications were analyzed by usingχ^(2) test or the rank sum test.A P value of<0.05 was considered as statistically significant difference.Results The operation time,first postoperative exhaust,defecation time,the time of postoperative hospitalization and intraoperative bleeding in the extraperitoneal group were less than those in the intraperitoneal group respectively(P<0.05).The excellent rate of 80.6%of postoperative defecation in the extraperitoneal group was higher than 60.0%in the intraperitoneal group(P<0.05).The Kirwan incontinence grade in the extraperitoneal group was lighter than that in the intraperitoneal group(P<0.05).The incidence of 8.3%of postoperative complications was lower in the extraperitoneal group than 26.7%in the intraperitoneal group(P<0.05).Conclusion Compared with intraperitoneal sigmoidostomy,extraperitoneal sigmoidostomy is more safe and effective with rapid postoperative rehabilitation,reduced the complications and improved control of defecation.

关 键 词：直肠肿瘤 腹腔镜 结肠造口术 腹膜 排便 手术后并发症 

分 类 号：R73[医药卫生—肿瘤]