早期预防性回肠造口还纳的疗效分析及影响因素  

Therapeutic effect analysis and influencing factors of early preventive ileostomy return

作　　者：何万鹏 陈波[1] 涂元茂[1] 王国仲 彭超[1] HE Wanpeng;CHEN Bo;TU Yuanmao;WANG Guozhong;PENG Chao(Department of Gastrointestinal Surgery,Neijiang Municipal Second People's Hospital,Neijiang,Sichuang 641000,China)

机构地区：[1]四川省内江市第二人民医院胃肠外科,四川内江641000

出　　处：《现代医药卫生》2024年第1期77-80,87,共5页Journal of Modern Medicine & Health

摘　　要：目的 探索早期预防性回肠造口还纳的安全性和可行性及影响因素。方法 收集该院2019年1月至2023年1月行预防性回肠造口还纳的患者临床病历资料,根据造口还纳时间分为早期组(<3个月)54例和普通组(>3个月)140例,分析两组一般资料、术后恢复情况和并发症情况;对影响早期还纳决策的相关因素进行分析。结果 早期组在性别、术前合并症、新辅助放化疗、肿瘤位置、术后排便次数、腹胀发生率及并发症发生率与普通组比较,差异无统计学意义(P>0.05);两组在年龄、造口相关并发症、造口生活时间、术后放化疗、肿瘤分期比较,差异有统计学意义(P<0.05);早期组的住院时间、术后排气时间、术后排便时间早于普通组(P<0.05),肛门坠胀发生率高于普通组(P<0.05)。多因素分析显示,年龄(OR=0.836,95%CI 0.791~0.883,P=0.000)及肿瘤位置(OR=3.000,95%CI 1.139~7.899,P=0.026)是影响早期造口还纳的主要因素。结论 早期预防性回肠造口还纳对中高位直肠肿瘤的中青年患者是安全可行的,并能显著改善造口并发症患者的生活质量。Objective To explore the safety and feasibility of early preventive ileostomy return and influencing factors.Methods The clinical medical record data of the patients with ileostomy return in this hospital from January 2019 to January 2023 were collected.The patients were divided into the early stage group(<3 months,54 cases) and common group(>3 months,140 cases) according to the time of ileostomy return.The general data,postoperative recovery and complications in the two groups were analyzed;the related factors affecting early return decision-making were analyzed.Results There were no statistically significant differences in the gender,preoperative comorbidities,neoadjuvant chemoradiotherapy,tumor location,number of defecations after ileostomy closure,incidence rates of abdominal distension and complications between the early stage group and common group(P>0.05);the differences in the age,stomal related complications,stoma living time,postoperative chemoradiotherapy and tumor stage between the two groups were statistically significant(P<0.05);the duration of hospital stay,postoperative exhausting time and postoperative defecation time in the early group were earlier than those in the common group(P<0.05),and the incidence rate of anal bulge was higher than that in the common group(P<0.05).The multivariate analysis showed that the age(OR=0.836,95%CI 0.791-0.883,P=0.000) and tumor location(OR=3.000,95%CI 1.139-7.899,P=0.026) were the main factors influencing the early ileostomy return.Conclusion Early preventive ileostomy return is safe and feasible in young and middle-aged patients with median or high rectal tumor and could significantly improve the quality of life in the patients with stomal complications.

关 键 词：回肠造口术 直肠癌 早期还纳 疗效 影响因素 

分 类 号：R605[医药卫生—外科学]