桥接式自体消化液回输对直肠癌行预防性回肠造口患者的临床应用价值  

Clinical evaluation of intestinal fluid reinfusion with bridging intubation in rectal cancer patients with terminal ileostomy

作　　者：陆娴 邵燕 钱峻 刘寒旸 莫琪 张伟媛 LU Xian;SHAO Yian;QIAN Jun;LIU Hanyang;MO Qi;ZHANG Weiyuan(Wound Repair Center,the Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University,Changzhou,Jiangsu 213000,China;Gastrointestinal Surgery and Gastroenterology Center,the Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University,Changzhou,Jiangsu 213000,China;Department of Colrectal and Anal Surgery,the Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University,Changzhou,Jiangsu 213000,China;Office of Outpatient Service,the Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University,Changzhou,Jiangsu 213000,China)

机构地区：[1]南京医科大学附属常州第二人民医院创面修复中心,江苏常州213000 [2]南京医科大学附属常州第二人民医院胃肠病中心,江苏常州213000 [3]南京医科大学附属常州第二人民医院肛肠外科,江苏常州213000 [4]南京医科大学附属常州第二人民医院门诊办公室,江苏常州213000

出　　处：《手术电子杂志》2022年第3期42-45,共4页Electronic Journal of Medical Operations

基　　金：常州市第二人民医院护理科研一般项目资助,(2019HYB013)。

摘　　要：目的探讨桥接式自体消化液回输对接受腹腔镜直肠癌根治术并行预防性回肠造口的直肠癌患者的临床应用价值。方法回顾分析2018年1月—2021年11月期间在我院接受腹腔镜直肠癌根治术并行预防性回肠造口的44例直肠癌患者的临床资料,其中有21例患者在回纳小肠造口前,采用U型硅胶管连通造口回肠远近端肠管以引流部分肠液至远端肠管,归为架桥组,另23例未做特殊处理,归为对照组,比较两组患者术后3月时的全身营养状况,每日消化液丢失情况,术中测量的造口远端回肠管径、肠壁厚度、造口回纳后患者肛门恢复排气时间,每日排便次数。结果44例患者均顺利完成回肠造口回纳手术,架桥组术前总蛋白与白蛋白水平与对照组相比无显著差异[(45.1±9.7)g/L比(43.8±9.1)g/L,(36.0±4.4)g/L比(36.3±3.7)g/L,P>0.05];但架桥组每日消化液丢失量明显少于对照组[(459.1±27.1)mL/d比(837.4±23.6)mL/d,P<0.05]。架桥组术中测量的造口远端小肠管径大于对照组,肠壁厚度优于对照组。架桥组在回纳术后肛门恢复排气时间早于对照组,每日排便次数少于对照组。结论桥接式自体消化液回输,对于减少患者消化液丢失,减少废用性结肠炎发生,促进回纳术后肛门括约肌的功能恢复,均具有明显的效果。Objective To discuss and evaluate the intestinal fluid reinfusion(IFR)with bridging intubation in rectal cancer patients undergoing curative laparoscopic rectectomy with terminal ileostomy.Methods In the review of 44 rectal cancer patients from 04/01/2018 to 30/11/2019,all patients received curative laparoscopic rectectomy with terminal ileostomy,and they were randomly divided into IFR group(21 patients)and control group(23 patients).Data,including general status of nutrition and daily loss of intestinal fluid,were collected at the point of 3 months after surgery.Data,including diameter of distal ilium,thickness of distal ilium wall,were collected at the time of closure of ileostomy.Time of first flatus and daily bowl movements were recorded after closure of ileostomy.All data were analyzed and compared between the two groups.Results All patients'closure of ileostomy were successful.Serum prealbumin and albumin levels were similar between the 2 groups(45.1±9.7 g/L vs 43.8±9.1 g/L,36.0±4.4 g/L vs 36.3±3.7 g/L,P>0.05).Patients in IFR group lost less intestinal fluid than those in control group(459.1±27.1 mL/d vs 837.4±23.6 mL/d,P<0.05).Patients in IFR group had bigger diameter of distal ilium and thicker distal ilium wall,compared to distal ileal mucosa in control group patients.Earlier first flatus and less bowl movements were also observed in IFR group.Conclusion Intestinal fluid reinfusion with bridging intubation significantly reduces loss of intestinal fluid,significantly reduces incidence of chronic inflammation of distal ileal mucosa,and reduces bowl movements.

关 键 词：消化液回输 预防性造口 直肠癌 

分 类 号：R735.37[医药卫生—肿瘤]