腹腔镜低位和超低位直肠癌保肛根治术中改良襻式回肠末端造瘘的应用价值

摘要

目的 探讨腹腔镜低位和超低位直肠癌保肛根治术中预防性使用改良襻式回肠末端造瘘的临床应用价值.方法 回顾性分析2010年1月至2012年6月江苏省苏北人民医院收治的108例直肠癌患者的临床资料.所有患者采用腹腔镜低位或超低位直肠癌保肛根治术,其中53例采用预防性改良襻式回肠末端造瘘(预造瘘组),55例未采用预防性改良襻式回肠末端造瘘(未造瘘组).对两组患者术中和术后情况进行比较研究.计量资料采用(x-)±s表示,组间比较采用t检验;计数资料采用率或构成比表示,组间比较采用x2检验或Fisher确切概率法.结果 预造瘘组和未造瘘组患者手术时间分别为(185±14)min和(154±12) min,术中出血量分别为(31±26)ml和(28±19)ml,两组比较,差异无统计学意义(=2.34,1.82,P＞0.05);术后肛门排气时间分别为(1.1±0.3)d和(4.2±0.6)d,术后进食时间分别为(1.1±0.2)d和(4.3±0.6)d,盆腔引流管拔出时间分别为(5.2±1.0)d和(8.4±3.9)d,两组比较,差异有统计学意义(t=7.25,28.12,15.34,P＜0.05);并发症发生率分别为5.7％(3/53)和21.8％ (12/55),吻合口瘘发生率分别为0和12.7％ (7/55),两组比较,差异有统计学意义(P＜0.05);术后住院时间分别为(7.2±1.4)d和(12.9 ±4.4)d,治疗费用分别为(3.0±0.2)万元和(3.8±0.7)万元,两组比较,差异有统计学意义(t=34.01,7.83,P＜0.05).结论 对腹腔镜低位和超低位直肠癌保肛根治术患者施行预防性改良襻式回肠末端造瘘,能有效降低吻合口瘘的发生,有利于患者快速康复.%Objective To investigate the value of modified loop ileostomy in laparoscopic low and superlow radical resection of the rectal cancer with reservation of anus.Methods The clinical data of 108 patients who received laparoscopic low and super-low radical resection of rectal cancer with preservation of anus at the Subei Hospital of Jiangsu Province from January 2010 to June 2012 were retrospectively analyzed.Fifty-three patients who received preventive ileostomy were in the ileostomy group,and 55 patients who did not receive preventive ileostomy were in the non-ileostomy group.The operation,incidence of complication and follow-up of the 2 groups were analyzed.All data were analyzed using the t test,chi-square text or Fisher exact test.Results The operation time and blood loss were (185 ± 14)minutes and (31 ± 26)ml in the ileostomy group,and (154 ± 12)minutes and (28 ± 19)ml in the non-ileostomy group,with no significant difference between the 2 groups (t =2.34,1.82,P ＞ 0.05).The time to first flatus,time to liquid diet intake,time to pelvic drainage tube removal,duration of hospital stay,hospital costs were (1.1 ± 0.3) days,(1.1 ± 0.2) days,(5.2 ± 1.0) days,(7.2 ± 1.4) days,(3.0 ± 0.2) ×104 yuan in the ileostomy group,and (4.2 ± 0.6) days,(4.3 ± 0.6) days,(8.4 ± 3.9) days,(12.9 ±4.4)days,(3.8 ±0.7) × 104 yuan in the non-ileostomy group,with significant differences between the 2 groups (t =7.25,28.12,15.34,34.01,7.83,P ＜ 0.05).The incidences of postoperative complications and anastomotic fistula were 5.7％ (3/53) and 0 in the ileostomy group,and 21.8％ (12/55) and 12.7％ (7/55) in the non-ileostomy group,with significant differences between the 2 groups (P ＜ 0.05).Conclusion Modified loop ileostomy in laparoscopic low and super-low radical resection of rectal cancer can effectively reduce the incidence of anastomotic fistula,and helps the recovery of patients.