腹腔镜直肠癌根治术后预置造口与襻式回肠造口短期疗效评价:一项倾向性评分匹配队列研究  

Short-term efficacy of ghost ileostomy versus loop-type ileostomy following laparoscopic radical resection for rectal cancer:A propensity score matched cohort study

作　　者：王振宁 杨康[2,3] 王得晨[2,3] 邹敏 归明彬 王雅楠 徐明 Wang Zhenning;Yang Kang;Wang Dechen;Zou Min;Gui Mingbin;Wang Yanan;Xu Ming(Northwest University for Nationalities,Lanzhou 730030,China;Department of Anorectal Surgery,the 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army,Lanzhou 730030,China;Ningxia Medical University,Yinchuan 750004,China;Gansu University of Traditional Chinese Medicine,Lanzhou 730030,China)

机构地区：[1]西北民族大学,兰州730030 [2]中国人民解放军联勤保障部队第940医院肛肠科,兰州730030 [3]宁夏医科大学,银川750004 [4]甘肃中医药大学,兰州730030

出　　处：《中华普通外科学文献(电子版)》2025年第1期21-27,共7页Chinese Archives of General Surgery(Electronic Edition)

基　　金：甘肃省科技计划项目(21JR7RA006);院内科研计划项目(2021yxky018);西北民族大学中央高校基本科研业务费项目(31920200016)。

摘　　要：目的分析比较腹腔镜直肠癌根治术后预置造口与襻式回肠造口对中低位直肠癌患者的临床疗效。方法回顾性收集联勤保障部队第940医院2018年6月至2021年6月收治的161例限期行腹腔镜直肠癌根治术的中低位直肠癌患者病例资料,根据倾向性评分,按11匹配方法将患者分为预置造口组和襻式回肠造口组,各49例。比较两组患者的一般资料、术中情况、术中及术后并发症、造口相关并发症以及手术前后炎性因子的变化。结果相较于襻式回肠造口组,预置造口组住院花费减少(P=0.010),手术时长和住院时长也相对缩短(P<0.05),术中失血量减少(P=0.001),术后3个月内的再次手术比例、术后6个月造口状态比例和使用抗生素的天数更少(P<0.05);两组患者术前WBC、PCT和IL-6等炎性指标水平差异均无统计学意义,预置造口组术后1、2、3、5 d时炎性指标水平明显低于襻式回肠造口组(P<0.05)。结论预置造口是一种更安全、更有效且更节省住院时间和费用的手术方法,其应用于腹腔镜直肠癌根治术后并发症及相关造口并发症较少,有助于改善患者的预后。Objective To analyze and compare the clinical outcomes of ghost ileostomy and loop-type ileostomy following laparoscopic radical resection in patients with middle and low rectal cancer.Methods Data of 161 patients with middle and low rectal cancer who underwent elective laparoscopic radical resection in the 940th Hospital of Joint Logistics Support Force between June 2018 and June 2021 were retrospectively collected.Based on propensity score matching,the patients were divided into the ghost ileostomy group and the loop-type ileostomy group,with 49 patients in each group.The general clinical characteristics,intraoperative conditions,intraoperative and postoperative complications,stoma-related complications,and changes in inflammatory markers before and after surgery between the two groups were compared.Results Compared with the loop-type ileostomy group,the ghost ileostomy group had less hospitalization costs(P=0.010),shorter operative and hospitalization time(P<0.05),less intraoperative blood loss(P=0.001),and lower rates of reoperation within three months postoperatively,stoma state at six months postoperatively,and days of antibiotic use(P<0.05).There were no statistically significant differences in preoperative inflammatory markers such as WBC,PCT,and IL-6 between the two groups.However,the levels of inflammatory markers on day 1,2,3,and 5 postoperatively were significantly lower in the ghost ileostomy group compared to the loop-type ileostomy group(P<0.05).Conclusions Ghost ileostomy is a safer,more effective surgical method that reduces hospitalization time and costs.Its application in laparoscopic radical resection for rectal cancer is associated with fewer complications and stoma-related issues,contributing to better patient outcomes.

关 键 词：直肠肿瘤 倾向性评分 预置造口术 襻式回肠造口术 预后 

分 类 号：R735.37[医药卫生—肿瘤]