预防性回肠末端造口术对腹腔镜低位直肠癌根治性保肛手术患者炎症指标及肛门功能的影响  

Effects of prophylactic terminal ileostomy on inflammatory indexes and anal function in patients undergoing laparoscopic radical anal preservation surgery for low rectal cancer

作　　者：厉冰 王静 刘婕 王静亚 LI Bing;WANG Jing;LIU Jie;WANG Jingya(General Surgery Department,the First Affiliated Hospital of Henan University,Kaifeng 475000,China)

机构地区：[1]河南大学第一附属医院普通外科,河南开封475000

出　　处：《临床医学研究与实践》2024年第16期84-87,共4页Clinical Research and Practice

基　　金：开封市科技发展计划项目(No.2003032)。

摘　　要：目的分析预防性回肠末端造口术对腹腔镜低位直肠癌根治性保肛手术患者预后的影响。方法以2021年2月至2023年2月我院收治的86例采取腹腔镜低位直肠癌根治性保肛手术患者为研究对象,随机将其分为横结肠组(43例,预防性横结肠造口术)和回肠末端组(43例,预防性回肠末端造口术)。比较两组的治疗效果。结果两组的手术时长、术中出血量比较,差异无统计学意义(P>0.05);回肠末端组的排气时间、肠蠕动时间、首次排便时间及住院时长显著短于横结肠组(P<0.05)。回肠末端组的术后并发症总发生率显著低于横结肠组(P<0.05)。出院时、术后1个月及术后3个月,回肠末端组的Wexner评分显著低于横结肠组(P<0.05)。术后,回肠末端组的干扰素γ(IFN-γ)、前列腺素E2(PGE2)、髓过氧化物酶(MPO)及超敏C反应蛋白(hs-CRP)水平显著低于横结肠组(P<0.05)。出院时,回肠末端组的肛管最大静息压、肛管最大收缩压显著高于横结肠组,直肠最大静息压显著低于横结肠组(P<0.05)。结论腹腔镜低位直肠癌根治性保肛手术患者实施预防性回肠末端造口术可有效保障预后。Objective To analyze the effect of prophylactic terminal ileostomy on the prognosis of patients undergoing laparoscopic radical anal preservation surgery for low rectal cancer.Methods A total of 86 patients with low rectal cancer who underwent laparoscopic radical anal preservation surgery in our hospital from February 2021 to February 2023 were selected as the research objects and randomly divided into transverse colon group(43 cases,prophylactic transverse colostomy)and terminal ileum group(43 cases,prophylactic terminal ileostomy).The therapeutic effects of the two groups were compared.Results There were no significant differences in operation time and intraoperative blood loss between the two groups(P>0.05);the exhaust time,intestinal peristalsis time,first defecation time and hospitalization time in the terminal ileum group were significantly shorter than those in the transverse colon group(P<0.05).The total incidence of postoperative complications in the terminal ileum group was significantly lower than that in the transverse colon group(P<0.05).At discharge,1 month and 3 months after operation,the Wexner score of the terminal ileum group was significantly lower than that of the transverse colon group(P<0.05).After operation,the levels of interferon-γ(IFN-γ),prostaglandin E2(PGE2),myeloperoxidase(MPO)and high-sensitivity C-reactive protein(hs-CRP)in the terminal ileum group were significantly lower than those in the transverse colon group(P<0.05).At discharge,the maximum anal resting pressure and maximum anal systolic pressure of the terminal ileum group were significantly higher than those of the transverse colon group,and the maximum rectal resting pressure was significantly lower than that of the transverse colon group(P<0.05).Conclusion Prophylactic terminal ileostomy in patients undergoing laparoscopic radical anal preservation surgery for low rectal cancer can effectively guarantee the prognosis.

关 键 词：腹腔镜低位直肠癌根治性保肛手术 预防性回肠末端造口术 直肠手术 肛门功能 

分 类 号：R735.37[医药卫生—肿瘤]