管状吻合器及乙状结肠腹膜外造瘘在低位直肠癌Miles术中的应用研究

摘要

目的:探讨管状吻合器及乙状结肠腹膜外造瘘在低位直肠癌腹会阴联合直肠癌根治术( Miles术)中的应用效果,分析造瘘口并发症发生率和相关指标.方法:回顾分析我院58例行Miles术患者的临床资料, 58例患者分为吻合器造瘘组40例、传统法造瘘组18例,腹膜外造瘘组32例、腹膜内造瘘组26例,对比分析造瘘口情况及并发症.结果:与传统法造瘘组比较,吻合器造瘘组患者的造瘘口旁感染发生率低(P <0.05),对造瘘口满意度高(P<0.05);与腹膜内造瘘组比较,腹膜外造瘘组患者的造瘘肠管旁腹内疝发生率低(P<0.05),规律排便出现时间更短(P<0.05),规律排便后每天排便次数少(P<0.05),造瘘口旁疝、造瘘口脱出/回缩、造瘘口狭窄等并发症发生率差异均无统计学意义(P>0.05).结论:相比传统法造瘘和腹膜内造瘘,管状吻合器及乙状结肠腹膜外造瘘可减少术后造瘘口并发症,更适用于直肠癌Miles术患者.%Objective: To investigate the clinical effect of circular anastomotic stapler and extraperitoneal sigmoid colostomy in Miles surgery for low rectal cancer and to analyze the incidence and other related indicators of stoma complications.Methods: Fifty-eight patients with Miles surgery were enrolled retrospectively in this study , of whom 40 patients were assigned into anastomat fistulae group and 18 into traditional fistula group.They were subdivided into extraperitoneal fistulae group (32 cases) and intraperitoneal fistulae group (26 cases).The stoma conditions and complications were compared and analyzed between the groups.Results: Compared with traditional fistulae group, the stoma infection rate was lower and the satisfaction with the stoma was higher in anastomat fistulae group (P<0.05).In addition, compared with intraperitoneal fistulae group , the incidence of parenteral abdominal her-nia was lower, the regular defecation time was shorter and the time of regular defecation was reduced in extraperito-neal fistulae group (P<0.05).There was no statistical difference in parostomy hernia , fistulae/retraction, stenosis of stoma between the two groups ( P>0.05 ).Conclusion: Compared with traditional fistulae and intraperitoneal fistulae, circular anastomotic stapler and extraperitoneal sigmoid colostomy can reduce the incidence of stoma com -plications,which are more applicable to Miles surgery for low rectal cancer patients.