预防性回肠造口对直肠前切除术后吻合口瘘及低位前切除综合征的影响分析  

Effect of prophylactic stoma on postoperative anastomotic fistula and low anterior resection syndrome after anterior resection for rectal cancer

作　　者：管佳佳 骆杰[1] 傅军[1] 杭群[1] 朱磊磊 朱冰 Guan Jiajia;Luo Jie;Fu Jun;Hang Qun;Zhu Leilei;Zhu Bing(Department of Gastrointestinal Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China)

机构地区：[1]蚌埠医学院第一附属医院胃肠外科,233004

出　　处：《中华普通外科学文献（电子版）》2023年第5期332-335,共4页Chinese Archives of General Surgery(Electronic Edition)

基　　金：安徽省高等学校自然科学研究项目(KJ2021zd0090)。

摘　　要：目的 探讨预防性回肠造口对直肠前切除术后吻合口瘘及低位前切除综合征(LARS)的影响。方法 收集2018年12月至2020年12月蚌埠医学院第一附属医院行腹腔镜下中低位直肠癌前切除手术的245例患者资料,根据是否一期行预防性回肠造口分为常规组(161例)及造口组(84例),比较两组吻合口瘘发生率、二次手术率、术后住院时间、住院费用及术后3、6、12个月时LARS评分的变化。结果 造口组吻合口瘘发生率显著低于常规组,差异有统计学意义(3.57%vs 12.42%,χ^(2)=5.084,P=0.024);而两组二次手术率(0 vs 2.48%)、术后住院时间[(8.42±0.86) d vs (8.68±1.15) d]、平均住院费用[(5.42±0.36)万元vs(5.54±0.89)万元]差异无统计学意义。造口组术后3、6个月时的LARS评分分别为(25.5±2.4)分、(20.5±2.3)分,显著低于同期常规组的(34.3±4.1)分、(28.8±2.7)分,差异均有统计学意义(t=18.109、23.991,均P<0.001),但两组术后12个月时的LARS评分差异无统计学意义[(18.5±1.5)分vs (18.9±1.8)分,t=1.745,P=0.082]。结论 直肠前切除术中行预防性回肠造口,短期内可改善中低位直肠癌患者LARS评分和降低吻合口瘘检出率,但患者长期临床受益较少,可选择性开展。Objective To investigate the effect of prophylactic stoma on anastomotic fistula and low anterior resection syndrome(LARS)in patients with anterior resection for rectal cancer.Methods Clinical data of 245 cases with middle and low rectal cancer undergoing laparoscopic anterior resection for rectal cancer from December 2018 to December 2020 were collected.According to whether prophylactic ileostomy was performed,the patients were divided into two groups:routine group(161 cases)and stoma group(84 cases).The detection rate of anastomotic fistula,rate of secondary operation,length and costs of hospitalization,and score of LARS at 3-,6-,12-month after operation were compared between the two groups.Results The rate of anastomotic fistula in the stoma group was significantly lower than that in the routine group(3.57%vs 12.42%,χ^(2)=5.084,P=0.024).There were no significant differences in the rate of secondary operation(0 vs 2.48%),length of hospitalization[(8.42±0.86)d vs(8.68±1.15)d]and average costs of hospitalization[(5.42±0.36)×10^(4) yuan vs(5.54±0.89)×10^(4) yuan]between the two groups.The score of LARS in the stoma group was significantly lower than that in the routine group at postoperatively 3-month[(25.5±2.4)vs(34.3±4.1),t=18.109,P<0.001]and 6-month[(20.5±2.3)vs(28.8±2.7),t=23.991,P<0.001],but there was no significant difference between the two groups at 12-month postoperatively[(18.5±1.5)vs(18.9±1.8),t=1.745,P=0.082].Conclusion Prophylactic stoma in anterior rectal resection can improve LARS score and reduce the probability of anastomotic fistula in patients with middle and low rectal cancer in the short term,but patients can not have long-term benefit,which can be carried out selectively in clinic.

关 键 词：预防性造口 低位前切除综合征 直肠肿瘤 吻合口瘘 

分 类 号：R735.37[医药卫生—肿瘤]