经右下腹切口取标本并行预防性造口在腹腔镜下直肠癌低位前切除术中的应用  

Application of prophylactic ileostomy through right lower abdominal specimen extraction incision in lapa⁃roscopic rectal low anterior resection

作　　者：李星 王有财 徐勇超 唐礼恭 程方圆 LI Xing;WANG Youcai;XU Yongchao;TANG Ligong;CHENG Fangyuan(Department of General Surgery,the Affiliated Cancer Hospital of Zhengzhou University&He′nan Cancer Hospital,Zhengzhou 450008,He′nan,China)

机构地区：[1]郑州大学附属肿瘤医院,河南省肿瘤医院普外科,河南郑州450008

出　　处：《实用医学杂志》2024年第19期2720-2725,共6页The Journal of Practical Medicine

基　　金：河南省医学教育研究项目(编号:Wjlx2022037)。

摘　　要：目的探讨经右下腹切口取标本并行预防性造口在腹腔镜下直肠癌低位前切除术中应用的安全性、临床效果及对术后还纳手术的影响。方法回顾性分析2020年1月至2023年12月间我院普外科收治的腹腔镜下直肠癌低位前切除术并行回肠末段造口的127例患者临床资料。根据术中是否经右下腹切口取标本并行造口将患者分为两组:观察组60例经右下腹切口取标本并行预防性造口术,对照组67例经下腹正中切口取标本并另行造口术,比较两组患者的临床相关数据及造口还纳手术相关临床资料。结果(1)两组患者的相关基线资料比较差异无统计学意义(P>0.05),具有可比性。(2)观察组在手术时间、术后2 d内疼痛评分、术后排气时间方面比较均优于对照组,差异有统计学意义(P<0.05)。观察组造口切口长度大于对照组,组间比较差异有统计学意义(P<0.05)。在术中出血量、术后进食时间以及术后住院时间方面,组间比较差异无统计学意义(P>0.05)。(3)在术后相关并发症及造口相关并发症方面,组间比较差异无统计学意义(P>0.05)。(4)观察组在造口还纳术后疼痛评分及术后排气时间方面均优于对照组,差异有统计学意义(P<0.05)。在还纳手术时间、腹腔粘连程度、术中出血量、术后住院天数、术后并发症等方面,组间比较差异无统计学意义(P>0.05)。结论需行预防性造口的腹腔镜下直肠癌低位前切除术患者,经右下腹切口取标本并行预防性回肠造口可提高患者腹壁切口美观、缩短手术时间、减轻患者痛苦且不增加术后并发症及还纳手术难度,安全可行,值得临床推广。Objective To investigate the safety and clinical effect of prophylactic ileostomy using right lower abdominal specimen extraction incision in laparoscopic rectal low anterior resection and its impact on ileos-tomy closure.Methods A retrospective analysis was conducted on 127 patients who underwent laparoscopic low anterior resection of rectal cancer combined with prophylactic ileostomy in Department of General Surgery in our hospital from January 2020 to December 2023.Patients were divided into observation group(n=60)and control group(n=67)based on whether with prophylactic ileostomy using the right lower abdominal specimen extraction incision or not.Relevant data and clinical data of ileostomy closure were compared between the two groups.Results(1)There was no significant difference in baseline clinical data between the two groups(P>0.05).(2)In terms of operation time,pain score within three days after surgery and postoperative first exhaust time,the observation group was better than the control group,showing statistical difference(P<0.05).In the observation group,the average length of the incision was longer than that in the control group,and it was significantly different between the two groups(P<0.05).There was no significant difference between the two groups in terms of blood loss,post-operative feeding time and postoperative hospital stay(P>0.05).(3)There was no significant difference between the two groups in postoperative and ostomy-related complication S(P>0.05).(4)The observation group was better than the control group in terms of postoperative pain score and postoperative first exhaust time,indicating statistical significance(P<0.05).There were no significant differences in surgical time,abdominal adhesion,blood loss,postoperative hospital stay and postoperative complications between the two groups(P>0.05).Conclusion The patients undergoing laparoscopic rectal low anterior resection who needs prophylactic ileostomy using right lower abdominal specimen extraction incision can improve the appearance of t

关 键 词：直肠肿瘤 腹腔镜手术 辅助切口 回肠造口 

分 类 号：R657.1[医药卫生—外科学]