回肠末端改良自闭式造口在低位直肠癌保肛手术中的应用  

Application of Modified Terminal Ileum Cannula Ileostomy in Anal Sphincter Preserving Operation for LowRectal Cancer

作　　者：姜涛 张迎辉 李宁博 JIANG Tao;ZHANG Ying-hui;LI Ning-bo(Dengfeng People's Hospital,Dengfeng,Henan 452470)

机构地区：[1]登封市人民医院,河南登封452470

出　　处：《中国肛肠病杂志》2024年第4期13-16,共4页Chinese Journal of Coloproctology

摘　　要：目的:探究回肠末端改良自闭式造口在低位直肠癌保肛手术中的应用效果。方法:选择我院2020年1月至2023年6月择期行低位直肠癌保肛手术治疗患者71例,根据患者意愿选择具体造口方案,分为对照组39例和观察组32例。2组术前准备与术后护理方案相同,对照组患者行末端回肠襻式造口术,观察组患者行回肠末端改良自闭式造口术,比较2组患者手术指标,术后1周采用排便功能量表(Wexner)评估患者排便功能以及造口相关并发症发生率。结果:2组患者手术时间和术中出血量比较差异无统计学意义(P>0.05),观察组患者术后首次排气时间与首次进食时间均短于对照组(P<0.05)。观察组患者Wexner评分低于对照组(P<0.05)。对照组患者吻合口漏发生率为17.95%,观察组为3.13%,观察组患者吻合口漏发生率显著低于对照组(P<0.05);对照组患者总并发症发生率为25.64%,观察组为15.63%,观察组患者总并发症发生率低于对照组,但无统计学意义(P>0.05)。结论:在低位直肠癌保肛手术中采用回肠末端改良自闭式造口方案具有较好的临床效果,不但能加快患者康复进程、改善患者排便功能,而且还可以降低吻合口漏发生风险。Objective To explore the application effect of modified terminal ileum cannula ileostomy in a-nal sphincter preservation operation for low rectal cancer.Methods Total 71patients with low rectal cancer who underwent anal sphincter preservation operation in our hospital from January 2020to June 2023 were selected.According to the patient's wishes,the specific ileostomy plan was selected,and the patients were divided into control group(39cases)and observation group(32cases),with the same preoperative preparation and postoperative nursing program.The control group received terminal ileal loop-type ileosto-my,while the observation group received modified terminal ileum cannula ileostomy.The operative indexes of the two groups were compared,and the defecation function scale(Wexner)was used to evaluate the def-ecation function and the incidence of ostomy-related complications in the first week after operation.Re-sults There was no significant difference in operation time and intraoperative blood loss between the two groups(P>0.05).The first exhaust time and the first feeding time after operation in the observation group were shorter than those in the control group(P<0.05).The Wexner score of the observation group was lower than that of the control group(P<0.05).The incidence of anastomotic leakage in the control group was 17.95%,and 3.13%in the observation group,which was significantly lower in the observation group than in the control group(P<0.05).The total incidence of complications in the control group was 25.64%,and 15.63%in the observation group,which was lower in the observation group than in the con-trol group,but there was no significant difference(P>0.05).Conclusion The modified terminal ileum cannula ileostomy in the anal sphincter preservation operation for low rectal cancer has good clinical effect,not only can accelerate the rehabilitation process of patients and improve their defecation function,but also can reduce the risk of anastomotic leakage.

关 键 词：低位直肠癌 保肛手术 回肠末端改良自闭式造口 

分 类 号：R735.37[医药卫生—肿瘤]