部分盲肠壁埋于皮下改良盲肠造口与回肠末端造口在低位直肠癌保肛术中的临床效果比较  

Comparison of Clinical Effects of Partial Cecal Wall Buried in Subcutaneous Modified Cecal Stoma and Preventive Terminal Ileostomy in Anus Preservation for Low Rectal Cancer

作　　者：王冬芽 周青 刘昱昕 黄无浪 肖仁顺 WANG Dongya;ZHOU Qing;LIU Yuxin;HUANG Wulang;XIAO Renshun(Affiliated Hospital of Jinggangshan University,Ji’an 343000,China)

机构地区：[1]井冈山大学附属医院,江西吉安343000

出　　处：《中国医学创新》2023年第11期39-43,共5页Medical Innovation of China

基　　金：江西省卫健委科技计划项目(20203795)。

摘　　要：目的:探讨部分盲肠壁埋于皮下改良盲肠造口与预防性回肠末端造口在低位直肠癌保肛术中的应用和临床意义。方法:回顾性分析2019年1月-2022年2月井冈山大学附属医院普外科收治的101例低位直肠癌患者。50例行腹腔镜直肠低位前切除术(LAR)+部分盲肠壁埋于皮下改良盲肠造口术,纳入改良组,51例行腹腔镜LAR+预防性回肠末端造口术,纳入对照组。比较两组围手术期指标、吻合口瘘发生率、造口相关并发症、造口回纳率及生活质量。结果:改良组术后开始经口进食时间、术后排气时间均较对照组短(P<0.05),其余围手术期指标比较,差异均无统计学意义(P>0.05);两组吻合口瘘发生率比较,差异无统计学意义(P>0.05);改良组造口相关并发症发生率、造口回纳率均明显低于对照组(P<0.05);改良组术后6个月Wexner评分和生活方式、心理行为、抑郁/自我感受、窘迫尴尬评分均明显低于对照组(P<0.001)。结论:部分盲肠壁埋于皮下改良盲肠造口术的造口相关并发症发生率低,患者生活质量更高。Objective:To investigate the application and clinical significance of partial cecal wall buried in subcutaneous modified cecal stoma and preventive terminal ileostomy in anus preservation for low rectal cancer.Method:A retrospective analysis of 101 patients with low rectal cancer admitted to the General Surgery Department of Affiliated Hospital of Jinggangshan University from January 2019 to February 2022.50 patients who received laparoscopic low anterior resection(LAR)+partial cecal wall buried in subcutaneous modified cecal stoma were included in the modified group,while 51 patients who received laparoscopic LAR+preventive terminal ileostomy were included in the control group.The perioperative indicators indexes,incidence of anastomotic leakage,stoma-related complications,stoma recovery rate,and quality of life were compared between the two groups.Result:The time to start eating orally and the time to exhaust after operation in the modified group were shorter than those in the control group(P<0.05),there were no significant differences in other perioperative indicators(P>0.05).There was no significant difference in the incidence of anastomotic leakage between the two groups(P>0.05).The incidence of stoma-related complications and stoma recovery rate in the modified group were significantly lower than those in the control group(P<0.05).6 months after operation,the Wexner score,lifestyle,psychological behavior,depression/self-feeling,and embarrassment scores in the modified group were significantly lower than those in the control group(P<0.001).Conclusion:Partial cecal wall buried in subcutaneous modified cecal stoma has a low incidence of ostomy-related complications and higher quality of life for patients.

关 键 词：低位直肠癌 部分盲肠壁埋于皮下 改良盲肠造口术 预防性回肠末端造口 生活质量 

分 类 号：R735.37[医药卫生—肿瘤]