低位直肠癌保肛手术中三种末端回肠造口术近期临床效果的比较  

Study on the short-term clinical effect of the three ileal terminal stomy procedures in low rectal cancer

作　　者：张芳旭 张哲铭 孔帅 郑春宁 ZHANG Fang-xu;ZHANG Zhe-ming;KONG Shuai;ZHENG Chun-ning(Weifang Medical College,Weifang 261000,China;Department of Gastrointestinal Surgery,Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)

机构地区：[1]潍坊医学院,山东潍坊261000 [2]山东第一医科大学附属省立医院胃肠外科,山东济南250021

出　　处：《中国现代普通外科进展》2022年第12期956-959,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:对比低位直肠癌保肛手术中三种末端回肠造口术的近期临床效果。方法:回顾我院2018年11月至2020年11月131例行腹腔镜低位直肠癌根治术(Dixon)+末端回肠预防性造口术患者的病例资料。按照末端回肠造口术式不同分为传统组62例,一针法组38例,改良一针法组31例,比较三组患者造口和还纳手术时间、术中切除肠管长度和出血量以及术后并发症情况。结果:三组造口手术时间比较差异有统计学意义(P<0.001),传统组手术时间长于另外两组(P<0.001)。三组手术切除肠管长度、造口还纳手术时间比较均有统计学差异(P<0.001)。改良一针法组还纳时切除肠管长度和还纳时间最短。传统组术中切除肠管和还纳时间最长。三组术中出血量比较差异无统计学意义(P>0.05)。传统组术后并发症发生率为48.38%,一针法组为42.11%,改良一针法组为19.35%,三组比较差异有统计学意义(P<0.05)。结论:低位直肠癌保肛手术末端回肠造口术中,改良一针法造口操作简单,手术时间短,Ⅱ期还纳操作方便,切除肠管少,术后并发症发生率更低。Objective:To compare the short-term clinical effects of three kinds of prophylactic ileostomy on patients w ith low rectal cancer.Methods:The case data of 131 patients w ho underw ent laparoscopic radical resection of low rectal cancer(Dixon)+prophylactic terminal ilealstomy in our hospital from November 2018 to November 2020 w ere review ed.According to the different methods of ileostomy,the patients w ere divided into traditional ileostomy(n=62),one-needle ileostomy(n=38)and modified one-needle ileostomy(n=31).The operative time of stomy and reversion,the length of intraoperative bow el resection,the blood during surgery and the incidence of postoperative complications w ere compared among the three groups.Results:There w ere statistically significant differences among the three groups in operative time(P<0.001),The operation time of the traditional group(34.64±9.34)minutes w as significantly longer than that of the other tw o groups(P<0.001)and there w as no significant difference betw een the other tw o groups(P>0.05).It w as found that there w ere significant differences in the length of intestinal resection and the time of ileostomy(P<0.001).In the modified one-needle ileostomy group,the shortest intestinal resection length w as(8.00±0.88)cm and there w as significant difference among the three groups,w hile the traditional group had the longest time(111.74±17.54)min and the most intestinal resection(12.54±1.02)min during operation.There w as no significant difference in intraoperative blood loss among the three groups(P>0.05).In terms of the total incidence of complications,It w as 48.38%in the traditional group,42.11%in the one-needle ileostomy group and 19.35%in the modified one-needle ileostomy group in the three groups.The difference w as statistically significant(P<0.05).Conclusion:The postoperative complication rate of the modified one-needle method is low,the operation is simple,the operation time is short and the safety is high;At the same time,operation in Phase II is more convenient,removing

关 键 词：直肠肿瘤 低位 末端回肠造口 改良一针法 

分 类 号：R656.7[医药卫生—外科学]