低位直肠癌Miles术中腹膜外植入聚酯补片预防术后慢性放射性肠损伤的临床研究

Extraperitoneal Implanting Polyester Mesh During Miles Procedure for Low Rectal Carcinoma to Prevent Chronic Radiation Intestinal Injury：Clinical Study

为探讨低位直肠癌腹会阴联合切除术（Miles术）中腹膜外植入聚酯补片预防术后慢性放射性肠损伤的效果，将拟行Miles术的144例低位直肠癌（T3／N＋期）患者随机分为治疗组和对照组，各72例，治疗组术中盆底腹膜外植入大小适合的聚酯补片，修复盆底腹膜；对照组常规关闭盆底腹膜。对比两组患者术后骶前引流总量、引流时间、骶前感染率、会阴切口愈合情况、术后住院时间、医疗费用及放射性肠损伤的发生率。结果显示，两组患者术后骶前引流量、引流时间、骶前感染率、会阴切口愈合情况、术后住院时间及医疗费用比较差异均无统计学意义，P〉0．05。治疗组放疗后出现不完全性肠梗阻1例，经保守治疗缓解；对照组放疗后出现绞窄性肠梗阻、肠内瘘各1例，行手术治疗。治疗组慢性放射性肠损伤发生率（6．9％）明显低于对照组（22．2％），P〈0．05。结果表明，低位直肠癌Miles术中腹膜外植入聚酯补片可有效预防术后慢性放射性肠损伤。

In order to investigate the efficacy of extraperitoneal implanting polyester mesh during Miles procedure for low rectal carcinoma to prevent chronic radiation intestinal injury, author＇s department randomly divided the 144 patients to be subjected to Miles procedure for their T3/N＋ stage of low rectal carcinoma into treatment group and control group,72 cases for each group;during treatment group was extraperitoneal implanted with suitable size of polyester mesh at pelvic floor to repair pelvic floor peritoneum, while control group received routine closure of pelvic floor peritoneum; then the postoperative total drain- age volume at sacroanterior position,time for drainage,infection rate at this position, healing status of peri- neum wound,hospitalization time, and incidence of radiation intestinal injury, as well medical costs were compared between both groups. As results, among above items there was no statistical difference （ P 〉0.05） ,except for the incidence of radiation injuries;after radiation therapy in treatment group 1 case had incomplete intestinal obstruction which became relief through conservative treatment, while in control group 1 case had strangulated intestinal obstruction, 1 case had intra-intestinal fistula who all received surgery;thus,the incidence of radiation intestinal injuries in treatment group was significantly lower than in control group（6.9% vs 22.2%, P 〈0.05）. It is concluded that implanting polyester mesh can effectively prevent from the chronic intestinal injuries due to postoperative radiation.