直肠癌腹腔镜腹会阴联合切除术腹膜外造口与腹膜内造口的比较

Comparison of Extraperitoneal and Intraperitoneal Colostomy After Laparoscopic Abdominoperineal Resection for Rectal Cancer

目的探讨直肠癌腹腔镜腹会阴联合切除术中腹膜外造口的临床价值。方法回顾性分析我院2009年5月~2015年4月89例直肠癌腹腔镜腹会阴联合切除术的临床资料,评估腹膜内造口和腹膜外造口手术时间、术后并发症、排便感的差异。结果 2组造瘘手术时间无统计学差异[(23.5±5.6)min vs.(21.8±3.2)min,t=1.730,P=0.087];2组造瘘口狭窄各1例,无统计学差异(Fisher精确检验,P=1.000);2组造瘘口旁疝无统计学差异(0例vs.3例,Fisher精确检验,P=0.101)。腹膜外造口组术后4周排便感39例,显著多于腹膜内造口组3例(χ~2=51.185,P=0.000)。术后6个月2组患者均有排便感。结论腹腔镜腹膜外乙状结肠造口有一定优势。

Objective To discuss the clinical significance of extraperitoneal sigmoid colostomy after laparoscopic abdominoperineal resection （APR） for rectal cancer. Methods Clinical data of 89 cases of laparoscopic APR in our hospital from May 2009 to April 2015 were retrospectively analyzed. The surgical time, postoperative complications and sense of defecation were compared between extraperitoneal sigmoid colostomy and intraperitoneal sigmoid colostomy. Results There were no differences in operative time [ （23. 5 ± 5. 6） min vs. （21.8 ±3.2） min, t = 1.730 , P =0 . 087 ] , stenosis incidence （1 case vs. 1 case, Fisher ’ s exact test, P = 1.000）,or parastomal hernia incidence （0 vs. 3 cases, Fisher’s exact test,P =0 . 101） between extraperitoneal and intraperitoneal sigmoid colostomy groups. After 4 weeks there were 39 cases of sense of defecation in the extraperitoneal sigmoid colostomy group and 3 cases in the intraperitoneal sigmoid colostomy group. The difference was significant = 51.185, P =0 . 000）. All the patients in both groups had sense of defecation after 6 months. Conclusion Laparoscopic extraperitoneal sigmoid colostomy after APR has some advantages.