改良回肠功能性端端吻合和侧侧吻合在回肠袢式造口还纳术中应用的短期疗效分析  

Short-term efficacy of modified functional end-to-end ileal anastomosis versus side-to-side ileal anastomosis in ileal loop ostomy closure surgery

作　　者：钱正鹏 朱成章 张纪鹏 周子腾 杜斌斌 吕耀春[3] 徐世赟[3] 吴德望 Zheng-Peng Qian;Cheng-Zhang Zhu;Ji-Peng Zhang;Zi-Teng Zhou;Bin-Bin Du;Yao-Chun Lv;Shi-Yun Xu;De-Wang Wu(The First Clinical Medical College,Gansu University of Chinese Medicine,Lanzhou 730000,Gansu Province,China;The First Clinical Medical College,Lanzhou University,Lanzhou 730000,Gansu Province,China;Department of Anorectal Surgery,Gansu Provincial People’s Hospital,Gansu Clinical Medical Research Center for Anorectal Diseases,Lanzhou 730000,Gansu Province,China)

机构地区：[1]甘肃中医药大学第一临床医学院,甘肃省兰州市730000 [2]兰州大学第一临床医学院,甘肃省兰州市730000 [3]甘肃省人民医院肛肠科,甘肃省肛肠疾病临床医学研究中心甘肃省兰州市730000

出　　处：《世界华人消化杂志》2025年第4期276-282,共7页World Chinese Journal of Digestology

基　　金：兰州市科技计划项目,No.2023-2-102;甘肃省人民医院院内科研基金项目,No.23GSSYYB-2;陇南市科技计划项目,No.2023-S.QKJ-14;甘肃省教育厅:优秀研究生“创新项目”,No.2025CXZX-946.

摘　　要：背景在直肠癌治疗领域,回肠袢式造口术对患者术后肠道功能恢复至关重要.直肠癌低位前切除术后,回肠袢式造口被广泛应用以降低吻合口瘘风险,诸多研究均证实了这一点.当然,也有学者提出保护性回肠造口的作用有限,但就目前而言,大部分专家仍肯定低位直肠癌保护性造口在具有高危吻合口瘘的患者中的应用价值(如新辅助治疗后、低蛋白血症、超低位保肛等患者).随着回肠袢式造口手术的广泛开展,回肠造口还纳术的安全性和效果已成为外科医生关注的核心问题.传统的回肠侧侧吻合术因其操作相对简便而被广泛应用于回肠造口的还纳.然而,我们团队发现改良回肠功能性端端吻合术似乎在效果上更具优势,由于吻合口张力相对较小且血供更好,尤其是在术后肠道功能恢复方面表现出潜在的益处.尽管侧侧吻合术以其便捷的操作和广泛的临床应用而受到青睐,但在术后恢复速度方面的潜在不足也引发了我们的关注.目的本研究聚焦低位直肠癌前切除术后保护性回肠造口还纳的手术方式,旨在对比回肠侧侧吻合与改良回肠功能性端端吻合在回肠袢式造口还纳术中的短期疗效.方法采用回顾性研究方法,收集2020-06/2023-09甘肃省肛肠疾病临床医学研究中心204例接受直肠癌前切除术并同期施行回肠袢式造口还纳术患者的临床资料,依据吻合方式分为侧侧吻合组(简称A组,102例)和改良端端吻合组(简称B组,102例).对两组患者的基线资料、术中及术后多项指标,以及术后两周内并发症发生情况进行观察记录,并运用SPSS 26.0软件进行统计学分析.结果结果显示,两组患者在性别、年龄和BMI方面均衡可比.在手术及术后恢复关键指标方面指标上,改良回肠功能性端端吻合组的造口还纳术后通气时间(1.5 d±0.7 d)显著短于侧侧吻合组(2.0 d±0.6 d)(t=5.93,P<0.01),术后首次进食流质饮食时BACKGROUND In rectal cancer treatment,ileal loop ostomy is crucial for the recovery of postoperative intestinal function in patients.After low anterior resection for rectal cancer,ileal loop ostomy has been widely used to reduce the risk of anastomotic leakage,a benefit confirmed by numerous studies.Although some scholars have argued that protective ileostomy has limited efficacy,most experts currently recognize its value in patients with high-risk anastomotic leakage following low rectal cancer resection,such as those who have undergone neoadjuvant therapy,suffer from hypoproteinemia,or require ultra-low sphincter preservation.With the widespread application of ileal loop ostomy,the safety and efficacy of ileostomy closure have become core concerns for surgeons.Traditional side-to-side ileal anastomosis is commonly used for ostomy reversal due to its relatively simple technique.However,our team has observed that modified functional end-to-end ileal anastomosis may offer superior outcomes,as it involves lower anastomotic tension and better blood supply,particularly demonstrating potential benefits in postoperative intestinal functional recovery.While side-to-side anastomosis is favored for its operational convenience and extensive clinical use,its potential shortcomings in postoperative recovery speed have drawn our attention.AIM To compare the short-term efficacy of side-to-side ileal anastomosis and modified functional end-to-end ileal anastomosis in ileal loop ostomy closure after low anterior resection of rectal cancer.METHODS A retrospective study was conducted to collect the clinical data of 204 patients who underwent rectal cancer anterior resection and simultaneous ileal loop ostomy closure surgery at the Gansu Clinical Medical Research Center for Anorectal Diseases from June 2020 to September 2023.The patients were divided into either a side-to-side anastomosis group(102 cases)or a modified end-to-end anastomosis group(102 cases)based on the anastomotic method used.Baseline data,intraoperative and postop

关 键 词：回肠侧侧吻合 改良回肠功能性端端吻合 回肠袢式造口 短期疗效 

分 类 号：R735.3[医药卫生—肿瘤]