腹腔镜下腹膜外造口联合盆底腹膜重建的应用

Laparoscopic extraperitoneal sigmoid colostomy and pelvic peritoneal suture after abdomino-perineal resection for rectal cancer

目的评价腹膜外乙状结肠造口和盆底腹膜缝合在腹腔镜腹会阴联合直肠癌切除术(APR)中的应用价值。方法回顾性分析腹膜内乙状结肠造口、不缝合盆底腹膜(对照组)和腹膜外乙状结肠造口、缝合盆底腹膜(试验组)两种治疗策略在术后造口相关并发症及肠梗阻发生率方面的差异。结果对照组45例,术后造口旁疝8例,狭窄、缺血坏死和粘连性肠梗阻各1例;试验组36例,术后造口旁疝、狭窄和肠梗阻各1例;试验组造口旁疝发生率显著低于对照组(P<0.05),两组术后肠梗阻发生率差异无统计学意义。结论腹膜外乙状结肠造口可降低腹腔镜APR术后造口旁疝发生率和提高术后患者生活质量,值得推广应用。

Objective To evaluate the value of laparoscopic extraperitoneal sigmoid colostomy and pelvic reconstruction after abdomino-perineal resection （APR） for rectal cancer. Methods A retrospective study was performed of patients undergoing two laparoscopic therapeutic strategies （Control group, intraperitoneal colostomy ＋ nonsuture of pelvic peritoneum ; Case group, extraperitoneal colostomy ＋ suture of pelvic peritoneum）. Stoma related complications and intestinal obstructions between these two strategies were analyzed and compared after surgery. Results Eight parastomal hernias, one isehemic necrosis, one stenosis and one intestinal obstruction occurred in control group composed of 45 patients, whereas only two was diagnosed as stoma1 stenosis and intestinal obstruction respectively in case group composed of 36 patients. The difference regarding overall stoma related complications or parastomal hernia was significant （P 〈0.05 ）, but as for intestinal obstruction it did not reach a statistical significance. Conclusion Laparoscopic extraperitoneal sigmoid colostomy may reduce the incidence of parastomal hernia and improve quality of life after APR, thus it is worth popularizing application in clinic.