预防性造口在低位直肠癌手术中的应用分析

Protective Stoma for Reduction of the Anastomotic Leakage after Low Anterior Resection of the Rectum Cancer

目的探讨预防性造口在低位直肠癌手术中的应用价值。方法采用病例对照研究，将湖南省攸县人民医院普外科2011年1月～2013年4月期间共46例低位直肠癌患者分为两组：26例行预防性回肠造口（A组），其中23例为回肠双腔造口，3例为回肠单腔造口，术后3月回纳造口；20例未行预防性造口（B组）。对比其术后吻合口漏、肠梗阻、切口感染等并发症发生率。结果46例患者中共发生7例吻合口漏，其中A组2例（7．7％），B组5例（25％），且死亡1例，两组比较无显著性差异（P〉0．05）；切口感染率A组6例（23．1％），B组5例（25％），两组比较无明显差异（P〉0．05）；肠梗阻发生率A组1例（3．8％），B组3例（15％），两组比较无显著性差异（P〉0．05）。结论预防性造口可有效降低低位直肠癌术后吻合口漏发生率。对存在2个以上危险因素，尤其是超低位直肠癌（距肛缘低于5em）推荐行预防性造口术。

Objective To explore the protective stoma for reduction of the anastomotic leakage after low anterior resection of the rectum cancer. Methods In this case control study, during the period of January 2011 to April 2013, a total of 46 patients were enrolled with low rectal cancer patients in the Department of General Surgery, Youxian People＇s Hospital of Hunan Province. All the cases were divided into two groups, in which 26 patients underwent prophylactic ileostomy （ group A）, including 23 cases of ileum double cavity sto- ma, 3 cases of single cavity ileostomy, and 20 cases without prophylactic ileostomy （ group B）. Postoperative anastomotic leakage, intestinal obstruction, and wound infection rate were compared. Results A total of 7 cases of anastomotic leakage occurred. 2 cases （7.7%） occurred in group A and 5 cases （25%） occurred in group B. The difference between the two groups was not significant （ P 〉 0.05 ）. The incision infection rate of group A and B was 23.1% and 25 % respectively. There was no significant difference between the two groups （P 〉 O. 05 ）. The intestinal obstruction rate of group A and B was 3.8% and 15% respectively. The difference between the two groups was not significant （P 〉 O. 05 ）. Conclusion It can effectively reduce the incidence of postoperative anastomotic leakage of the preventive colostomy for low rectal cancer. It is recommended of the preventive colostomy on the existence of 2 or more risk factors, especially for the ultra low rectal cancer with the lower edge from the anal margin less than 5cm.