Objective To assess the value of protective stoma in low anterior resection for rectal cancer prospectively. Methods One hundred patients with mid and low rectal cancer who undergone selective open low anterior resection in our hospital from October 2006 to October 2011, fitting inclusion criteria, were randomized into three groups. Group A (33 cases) received per-ascending colon ileostomy with a Foleys tube after colorectal anastomosis. Group B (35 cases) received loop transverse colostomy or terminal ileostomy. Group C (32 cases) received no protective stoma. The occurrence rate of anastomotic leakage and stoma-related complications were collected. Results Five patient developed anastomotic leakage in all 100 patients with a rate of 5. 0% . The occurrence rate of anastomotic leakage in group A, B, C was 6.1% (2/33) , 5. 7% (2/35) and 3.1% (1/32) , respectively, and there was no statistic difference among three groups (P = 0. 838). The occurrence rate of anastomotic leakage in 68 patients with a protective stoma (group A and B) was 5.9% (4/68) , while it was 3. 1 % (1/32) in 32 patients without protective stoma (group C) , and there was no statistic difference between them ( P = 0. 922). Four patients ( in group A and B) with a protective stoma had slight symptoms , while one patient (in group C) without protective stoma had severe symptoms when anastomotic leakage occurred. Only two patients in group A temporally developed abdominal fistulae passing intestinal contents after the Foleys tube removed, and the fistulae healed soon by change of dressing. However, the occurrence rate of stoma complications and later stoma-closure complications in group B was high to 25. 7% (9/35) and 22. 9% ( 8/35). Conclusions A protective stoma can not reduce the incidence of anastomotic leakage after low anterior resection for rectal cancer, but can improve clinical manifestations after leakage. Traditionary protective transverse colostomy or terminal ileostomy has high incidence of stoma-related complications. Per-ascending colon tube ileostomy is an ideal alternative for patients with risk factors associated with anastomotic leakage.%目的 前瞻性评价保护性造口在直肠癌低位前切除术中的价值. 方法 选择2006年10月～2011年10月间在我院接受择期开腹根治性低位前切除术,并符合入选标准的100例中下段直肠癌患者,随机分为三组:A组33例在完成结直肠吻合后行经升结肠回肠置管造口术；B组35例行横结肠或末段回肠袢式造口术；C组32例不行保护性造口术.观察吻合口漏的发生率以及造口相关的并发症. 结果 100例患者术后发生吻合口漏5例,总的吻合口漏发生率为5.0％.A、B、C组的吻合口漏发生率分别为6.1％ (2/33)、5.7％(2/35)和3.1％ (1/32),组间比较无统计学差异(P=0.838,P＞0.05).68例行保护性造口患者(A+B组)和32例不行保护性造口患者(C组)术后吻合口漏的发生率分别为5.9％(4/68)和3.1％(1/32),无统计学差异(P=0.922,P＞0.05).4例(A、B组)有保护性造口发生吻合口漏的患者症状较轻,而1例(C组)无保护性造口发生吻合口漏患者的症状较重.A组中仅2例在拔除回肠置管后发生腹壁瘘口短暂的溢肠内容物现象,经换药后很快愈合.而B组中肠造口并发症的发生率为25.7％(9/35),后期造口还纳术并发症的发生率为22.9％(8/35).结论 保护性造口不能降低直肠癌低位前切除术后吻合口漏的发生,但能减轻吻合口漏发生后的症状.传统的保护性横结肠或末段回肠袢式造口术造口相关的并发症发生率较高.对具有吻合口漏高危因素患者,经升结肠回肠置管造口术是一种理想的可供选择的方法.
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