肠液回输在低位直肠癌患者直肠前切除并预防性回肠造口术后的应用  

Application of intestinal fluid reinfusion after anterior resection of rectum and preventive ileostomy in patients with low rectal cancer

作　　者：邹婷 张芳芳 王美 邓欣 张晶芬 倪淑芬 Zou Ting;Zhang Fangfang;Wang Mei;Deng Xin;Zhang Jingfen;Ni Shufen(Department of Tumor Surgery,Zhejiang Jinhua Guangfu Tumor Hospital,Jinhua 321001,China;Department of Respiratory Medicine,Zhejiang Jinhua Guangfu Tumor Hospital,Jinhua 321001,China;Nursing Department,Zhejiang Jinhua Guangfu Tumor Hospital,Jinhua 321001,China;Department of Radiology,Zhejiang Jinhua Guangfu Tumor Hospital,Jinhua 321001,China)

机构地区：[1]浙江金华广福肿瘤医院肿瘤外科,金华321001 [2]浙江金华广福肿瘤医院呼吸内科,金华321001 [3]浙江金华广福肿瘤医院护理部,金华321001 [4]浙江金华广福肿瘤医院放射科,金华321001

出　　处：《中国医师进修杂志》2023年第9期832-837,共6页Chinese Journal of Postgraduates of Medicine

基　　金：金华市科技计划项目(2021-4-084)。

摘　　要：目的:分析肠液回输在低位直肠癌患者直肠前切除并预防性回肠造口术后的作用。方法:采用前瞻性研究的方法,选取2021年1月至2022年6月浙江金华广福肿瘤医院低位直肠癌患者60例,按照随机数字表法分为对照组(采用直肠前切除并预防性回肠造口术治疗)和观察组(采用直肠前切除并预防性回肠造口术联合肠液回输治疗),每组30例。术后次日和术后3个月采用低位前切除综合征(LARS)评分量表评估肛门功能,采用患者参与主观整体评定(PG-SGA)法评估营养状况,采用造口患者生命质量量表(stoma-QOL)评估生命质量;记录并发症发生情况。结果:两组患者均顺利完成预定手术。两组术后次日LARS评分和LARS发生率比较差异无统计学意义( P>0.05);观察组术后3个月LARS评分和LARS发生率明显低于对照组[(18.63 ± 3.15)分比(24.90 ± 6.11)分和23.33%(7/30)比46.67%(14/30)],差异有统计学意义( P<0.01或<0.05)。两组术后次日PG-SGA评分和营养不良发生率比较差异无统计学意义( P>0.05);观察组术后3个月PG-SGA评分和营养不良发生率明显低于对照组[(3.07 ± 0.82)分比(5.13 ± 1.01)分和26.67% (8/30)比46.67%(14/30)],差异有统计学意义( P<0.01或<0.05)。两组术后次日stoma-QOL的心理负担、社会交往、造口管理和日常起居评分比较差异无统计学意义( P>0.05);观察组术后3个月各项评分明显高于对照组[(27.70 ± 4.28)分比(21.47 ± 5.16)分、(14.33 ± 2.03)分比(11.90 ± 1.64)分、(14.87 ± 1.92)分比(11.57 ± 2.38)分和(15.30 ± 1.03)分比(12.37 ± 2.11)分],差异有统计学意义( P<0.01)。观察组并发症发生率明显低于对照组[30.00%(9/30)比60.00%(18/30)],差异有统计学意义( χ^(2)= 5.45, P<0.05)。 结论:针对低位直肠癌患者,实施直肠前切除并预防性回肠造口术联合肠液回输可减少LARS,改善营养状态,提高生命质量,还可减少并发症。Objective To analyze the effect of intestinal fluid reinfusion after anterior resection of rectum and preventive ileostomy in patients with low rectal cancer.Methods A prospective research method was used,and 60 patients with low rectal cancer in Zhejiang Jinhua Guangfu Tumor Hospital from January 2021 to June 2022 were enrolled.The patients were divided into control group(treated with anterior resection of rectum and preventive ileostomy)and observation group(treated with anterior resection of rectum and preventive ileostomy combined with intestinal fluid infusion)by random number table method with 30 cases each.On the next day and 3 months after surgery,the low anterior resection syndrome(LARS)scale was used to evaluate anal function,the patient-generated subjective global assessment(PG-SGA)method was used to evaluate nutritional status,the stoma-quality of life(stoma-QOL)was used to evaluate the quality of life.The complications were recorded.Results Both groups of patients were successfully completed the scheduled surgery.There were no statistical differences in LARS score and incidence of LARS on the next day after surgery between the two groups(P>0.05);the LARS score and incidence of LARS 3 months after surgery in observation group were significantly lower than those in control group:(18.63±3.15)scores vs.(24.90±6.11)scores and 23.33%(7/30)vs.46.67%(14/30),and there were statistical differences(P<0.01 or<0.05).There were no statistical differences in PG-SGA score and incidence of malnutrition on the next day after surgery between the two groups(P>0.05);the PG-SGA score and incidence of malnutrition 3 months after surgery in observation group were significantly lower than those in control group:(3.07±0.82)scores vs.(5.13±1.01)scores and 26.67%(8/30)vs.46.67%(14/30),and there were statistical differences(P<0.01 or<0.05).There were no statistical differences in the scores of psychological burden,social interaction,stoma management and daily living of stoma-QOL on the next day after surgery between the two

关 键 词：直肠肿瘤 直肠前切除术 回肠造口术 肠液回输 肛门功能 

分 类 号：R735.37[医药卫生—肿瘤]