改良一针法末端回肠造口术对低位直肠癌保肛术后应激反应及安全性的影响  

Effect of modified one-shot terminal ileostomy on stress response and safety after anal preservation for lowrectalcancer

作　　者：赵梓竣 兰运升 Zhao Zijun;Lan Yunsheng(Department of Gastrointestinal Surgery,Suining Central Hospital,Suining Sichuan Province 629000,China)

机构地区：[1]遂宁市中心医院胃肠外科,四川遂宁629000

出　　处：《中华普外科手术学杂志（电子版）》2024年第6期611-614,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探究低位直肠癌保肛术患者接受改良一针法末端回肠造口术对其应激反应、安全性等的影响。方法回顾性分析2021年1月至2023年1月收治的低位直肠癌保肛术患者资料,按造口方案不同将患者分为观察组(接受改良一针法末端回肠造口术,n=55例)与对照组(接受传统末端回肠造口术,n=43例)。以SPSS 22.0软件分析数据,围手术期各项指标、不同时间肛门动力学与应激反应指标以(χ±s)表示,组间比较独立样本t检验;组间多时点对比以重复测量的方差分析。术后并发症以例和百分率表示,采用χ^(2)检验。P<0.05差异有统计学意义。结果观察组患者手术时间、术后恢复时间均明显短于对照组(P<0.05);两组患者不同时间点各肛门动力学指标组内呈现先下降后上升趋势(均P<0.05),且观察组患者术后6个月各肛门动力学指标均明显高于对照组(P<0.05);两组患者不同时间点各应激反应指标[白细胞计数(WBC)、C-反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)]组内呈现先上升后下降趋势(均P<0.05),且观察组患者术后2d TNF-α明显低于对照组(P<0.05),术后5d各应激反应指标均明显低于对照组(P<0.05);观察组患者造口相关并发症总发生率明显低于对照组(3.6% vs. 20.9%,P<0.05)。结论改良一针法末端回肠造口术对低位直肠癌保肛术后应激反应及安全性均有积极影响,可缩短手术时间,促进患者恢复。Objective To explore the effects of modified one-needle terminal ileostomy on stress response and safety of patients undergoing anal preservation for low rectal cancer.Methods The data of patients with rectal preservation for low rectal cancer admitted from January 2021 to January 2023 were retrospectively analyzed,and the patients were divided into observation group(modified one-needle terminal ileostomy,n=55 cases)and control group(traditional terminal ileostomy,n=43 cases)according to different stomy schemes.SPSS 22.0 software was used to analyze the data.Perioperative indexes,anal dynamics and stress response indexes at different times were expressed as(χ±s).Independent sample t test was performed between groups.Analysis of variance between groups with multiple time point comparisons to repeat measures.The cases and percentage of postoperative complications were expressed byχ^(2) test.P<0.05 was statistically significant.Results The operation time and postoperative recovery time in the observation group were significantly shorter than those in the control group(P<0.05).The anal dynamic indexes in the two groups showed a trend of first decreasing and then increasing at different time points(all P<0.05),and the anal dynamic indexes in the observation group were significantly higher than those in the control group 6 months after surgery(P<0.05).The stress response indexes(white blood cell count(WBC),C-reactive protein(CRP),tumor necrosis factorα(TNF-α))in the two groups at different time points showed a trend of first increase and then decrease(all P<0.05),and postoperative 2d TNF-αin the observation group was significantly lower than that in the control group(P<0.05).The stress response indexes were significantly lower than those of control group at 5 days after operation(P<0.05).The total incidence of stomation-related complications in the observation group was significantly lower than that in the control group(3.6%VS.20.9%,P<0.05).Conclusion Modified one-needle terminal ileostomy has positive effects on

关 键 词：直肠肿瘤 直肠切除术 末端回肠造口术 改良一针法 应激反应 

分 类 号：R735.37[医药卫生—肿瘤]