预防性回肠袢式造口在腹腔镜直肠前切除术中的应用

Preventive loop ileostomy in laproscopic-assisted anterior resection for rectal cancer:with a report of 69 cases

目的探讨应用预防性末段回肠袢式造口在腹腔镜直肠前切除术中的临床价值及适应证。方法我院胃肠外科在1999年9月至2009年6月间对482例直肠癌患者行腹腔镜直肠前切除术,其中69例患者同时行预防性回肠袢式造口(A组),未行预防性造口者413例(B组),对两组的临床资料和随访情况进行回顾性分析。结果术后吻合口瘘总发生率为1.87%(9/482);A组与B组在年龄、TNM分期、术后吻合口瘘发生率等方面的差异无统计学意义(P(0.05);但两组的性别、高中低位直肠癌比、新辅助放化疗、吻合口血运偏差、肠道准备欠佳、双吻合器钉合欠佳等方面的差异有统计学意义(P(0.05),A组的男性比例、低位直肠癌比例、行新辅助放化疗比例、吻合口血运偏差患者比例、肠道准备欠佳患者比例、双吻合器钉合欠佳患者比例较B组高。结论应用末段回肠袢式造口预防高危患者腹腔镜直肠前切除术后吻合口瘘是安全可行的。

Objective To evaluate the clinical value and indications of preventive loop ileostomy in lapro- scopic - assisted anterior resection for rectal cancer. Methods From September 1999 to June 2009, 482 patients of rectal cancer were received laproscopic - assisted anterior resection. Among them, 69 cases received preventive loop ileostomy at the same time in group A, other 413 cases didn＇ t receive preventive loop ileostomy in group B. Results The morbidity of anastomotic leakage was 1.87% （9/482）, and there were no significant difference between two groups in age, TNM stage, incidence of anastomotic leakage. But significant difference were found in sex, location of rectal cancer, neoadjuvant radiochemotherapy, anastomotic blood supply, bowel preparation, quality of double stapling. The proportion of male, low rectal cancer, neoadjuvant radiochemotherapy, poor anastomotic blood sup- ply, poor bowel preparation, poor double stapling were higher in group A. Conclusion Application of loop ileosto- my for preventing anastomosic leakage in high - risk patients who received laproscopic - assisted anterior resection for rectal cancer is technically feasible and safe.