经腹膜外通路造设人工肛门术

The Operation of Anus Pareternaturalis Through Extraperitoneal Passage

目的 :探讨直肠癌腹会阴联合切除术后 ,经腹膜外通路人工肛门造设的方法及效果。方法 :回顾性分析 1985年 5月～ 2 0 0 2年 12月间 4 34例直肠癌腹会阴联合切除术后 ,经腹膜外通路 337例 (称腹膜外组 ) ,经腹膜内通路 97例 (称传统组 )分别造设人工肛门的结肠造口术后患者的临床资料 ,对有关数据作统计学处理。结果 :腹膜外组有 2例患者 (0 . 5 % )发现造口狭窄 ,5例患者 (1 4. 8% )发现造口周围炎 ,1例患者 (0 . 3% )发现造口旁疝 ,87例患者获排便感觉 ,并发症发生率为 2 . 1%。腹膜内组造口狭窄 11例 (11. 34% ) ,发现造口周围炎 3例 (5. 5 % )、造口回缩 2例 (2 .16 % )、造口脱垂 4例 (4. 12 % ) ,并发症发生率为 2 9 98% ,患者没有排便感觉。两组并发症发生率及排便感觉上都有明显差异 (P <0 .0 5 ,P <0 .0 5 )。结论 :直肠癌APR术后经腹膜外通路造设人工肛门术 ,较传统手术并发症少 ,手术操作简单 ,便于护理且可获排便感觉。

Objective:To evaluate the method and effect of the operation of anus pareternaturalis (AP) through extraperitoneal passage after abdomino-perineal resection(APR)of the rectum cancer.Methods:434 patients with rectal cancer received the APR from May 1985 to December 2002.The clinical data were retrospectively analyzed.Of them,337 cases (extraperitoneal group)were operated through extraperitoneal passage.Another 97 cases(traditional group)underwent the intraperitoneal passage.Results:The complications of extraperitoneal group included stenosis of stoma in 2 cases(0.59%),peritomal infection in 5 cases(1.48%);and parastomal hernia in 1 case(0.3%).The incidence of complications was about 2.1%,and 87 cases got defecation response in extraperitoneal group.The complication rate was 29.98% in traditional group,and complications included peri-stomal infection in 3 cases(3.09%),internal hernia in 4 cases(4.12%),para-stomal hernia in 5 cases(5.15%),stenosis of stomal in 11 cases(11.34%),retraction of stoma in 2 cases(2.16%),stomal prolapse in 4 cases(4.12%),and no case got defecation responses.There was a significant difference between the two groups(P<0.05).Conclusion:The operation of APR through extraperitoneal passage has less complication,which easier to manage,and has better functions of defection.