腹腔镜腹膜外乙状结肠造口的制作及应用

Manufacture and application of laparoscopic extraperitoneal sigmoid colostomy

目的探讨腹腔镜下腹膜外乙状结肠造口的安全性和可行性。方法前瞻性入组2011年7月至2012年7月间南京中医药大学第三附属医院肛肠中心收治的36例行腹腔镜腹会阴联合切除术的低位直肠癌患者，按随机数字表法分为腹膜内造口组和腹膜外造口组，每组18例。术后随访4～16（中位7）月，比较两组患者造口并发症情况。结果腹膜外造口组1例患者因乙状结肠近端拖出后肠壁血供障碍而改行腹膜内造口，故后续的分析中予以剔除。腹膜外造口组手术时间[（25．3±8．5）min]稍长于腹膜内造口组[（14．7±6．4）min]，但差异无统计学意义（P〉0．05）。两组各有1例术后早期（4周以内）出现造口缺血，均行造口重建手术；腹膜外造口组术后造口水肿发生率明显高于腹膜内造口组[35．3％（6／17）比0，P〈O．05]；两组术后早期总并发症发生率差异无统计学意义[58．8％（10／17）比27．8％（5／18），P〉O．05]。腹膜外造口组后期（超过4周）未出现并发症；腹膜内造口组出现1例造口脱垂、1例造口狭窄和2例造口旁疝，并发症发生率为22．2％（4／18），两组比较，差异有统计学意义（P〈0．05）。结论腹腔镜腹膜外乙状结肠造口操作并不比腹膜内造口复杂。且其后期造口并发症明显少于腹膜内造口。

Objective To investigate the safety and feasibility of laparoscopic extraperitoneal sigmoid colostomy. Methods Thirty-six patients with low rectal cancer undergoing lapmscopic abdominoperineal resection from July 2011 to July 2012 were prospectively enrolled in the study and randomly divided into extraperitoneal colostomy group （EPC, n=18） and internal peritoneal colostomy group （IPC, n=18）. Follow-up period was 4-16 （median, 7） months and postoperative complications were compared between two groups. Results One case in EPC group was converted to IPC because of poor blood supply of the proximal sigmoid, who was eliminated from the subsequent analysis. Compared with the IPC group, the surgery time was longer in EPC group [（25.3＋8.5） min vs. （14.7＋6.4） mini, while the difference was not statistically significant（P〉0.05）. Each group had 1 case of stoma ischemia, who both received the colostomy reconstructive surgery. The incidence of stoma edema was significantly higher in EPC group[35.3%（6/17） vs. O, P〈O.05）. The early postoperative complications rate did not significantly different between the two groups [58.8%（10/17） vs. 27.8%（5/18）, P〉0.05]. The late postoperative complications rate was 22.2% （4/18） in IPC group, including 1 case of stoma prolapse, 1 case of stoma stenosis and 2 cases of parastomal hernia. No later postoperative complication occurred in EPC group. Conclusion Extraperitoneal sigmoid colostomy is an easy and safe procedure with lower late complications as compared to internal peritoneal sigmoid colostomy.