管形吻合器在乙状结肠单腔造瘘术中应用的对比研究

Comparative Study on Circular Anastomotic Stapler for Sigmoid Colostomy

目的探讨管形吻合器在乙状结肠单腔造瘘术中的应用价值。方法 2008年1月~2009年12月,行腹腔镜低位直肠癌Miles手术42例,按手术组不同和患者要求采用管形吻合器行乙状结肠单腔造瘘20例（吻合器组）,采用传统的手工缝合造瘘22例（手工缝合组）,对2组手术成功率、术后并发症发生率、手术总时间、住院时间和住院总费用进行统计学分析。结果 2组手术均成功。2组术中出血量、清扫淋巴结个数、造瘘口并发症发生率差异无显著性（P〉0.05）。手工缝合组术后出现并发症4例,分别为造瘘口坏死2例、造瘘口旁疝2例,均再次手术治愈,吻合器组未出现并发症。吻合器组手术时间短[（165.0±16.3）min vs.（221.0±20.2）min,t=-9.734,P=0.000],肠功能恢复快[（43.8±3.5）h vs.（52.5±2.6）h,t=-9.081,P=0.000],术后住院时间短[（12.7±2.9）d vs.（15.7±2.1）d,t=-4.009,P=0.000],需要镇痛者少（8例vs.21例,χ2=15.074,P=0.000）,但住院总费用高[（2.30±0.11）万元vs.（2.16±0.24）万元,t=4.009,P=0.000]。结论吻合器在乙状结肠单腔造瘘术中的运用使手术时间明显缩短,术后并发症减少,在技术上是安全、可靠的,具有手术创伤小、术后疼痛轻、易护理的特点,值得推广。

Objective To explore the value of circular anastomotic stapler in sigmoid colostomy. Methods The clinical data of 42 patients who were treated by laparoscopic Miles＇ operation for low rectal cancer in our hospital from January 2008 to December 2009 was analyzed.The 42 patients were divided into anastomotic and conventional groups according to their requirements.The anastomotic group（20 patients） received sigmoid colostomy with circular anastomotic stapler,and the conventional group underwent colostomy with suturing techniques.The medical records including operation time and success rate,intraoperative blood loss,number of removed lymph nodes,postoperative complication rate,recovery time of gastrointestinal function,hospitalization cost,and hospital stay were compared between the two groups. Results All of 42 patients received the operations successfully.No significant difference was detected between the two groups in intraoperative blood loss,number of removed lymph nodes,complications rate（P0.05）.In the conventional group,4 patients developed complications after the operation,including two cases of necrosis at the colostomy site and two cases of artificial fistula-induced hernia.These four patients were then cured by a second operation.In the anastomotic group,no patient showed any complications,furthermore,it had significantly shorter operation time,recovery time of gastrointestinal function,and hospital stay [（165.0±16.3） min vs.（221.0±20.2） min,t=-9.734,P=0.000;（43.8±3.5） h vs.（52.5±2.6） h,t=-9.081,P=0.000;and（12.7±2.9） d vs.（15.7±2.1） d,t=-4.009,P=0.000,respectively],less needs for analgesia（8 cases vs.21 cases,χ2=15.074,P=0.000）,but higher hospitalization cost [（23.0±1.1） thousands RMB vs.（21.6±2.4） thousands RMB,t=4.009,P=0.000].Conclusion Circular anastomotic stapler is a safe,effective,and minimally invasive technique,it is worth being used widely for sigmoid colostomy owing to its advantages in reducing operation time and complication rate,less postoperative pain,and easy postoperative nursing care.