自闭性回肠插管造口预防直肠癌新辅助放化疗后低位前切除患者吻合口漏

Self close intubation ileostomy in the prevention of anastomotic leakage of anterior resection after neoadjuvant chemoradiation in patients of low rectal carcinoma

目的 探讨自闭性回肠插管造口在低位直肠癌新辅助放化疗后保肛手术预防吻合口漏的安全性和可行性.方法 收集2010-2013年浙江省德清县人民医院和浙江大学附属第一医院肛肠外科收治的54例中低位直肠癌新辅助放化疗后保肛手术患者的临床资料.54例随机分为两组,A组为自闭性回肠插管造口术28例,B组为传统回肠襻式造口术26例,观察两组患者术后并发症、安全性和经济、社会性等方面的意义.结果 两组回肠造口方式均对直肠吻合口有保护作用,其中A组保护时间平均为21（15 ～35）d,造口导管拔除后造口自动闭合（愈合）的成功率为100％;B组患者术后3～6个月再次行造口回纳术,术后出现严重并发症1例.两组术后均未出现明显的吻合口漏.结论 在中低位直肠癌新辅助放化疗后自闭性回肠插管造口术能够起到和传统回肠造口术相同的预防吻合漏的作用,且安全性高,医疗费用低,能有效避免再次造口回纳术给患者带来的创伤和经济负担.

Objective To explore the safety and applicability of a temporary protective ileostomy that closes itself in the prevention of anastomotic leakage following anterior resection after chemoradiation for rectal cancer.Methods From Oct 2010 to Oct 2013,54 cases of middle or low rectal carcinoma were admitted.Protective ileostomy was created to prevent anastomotic leakage.Patients were divided into two groups receiving respectively intubation ileostomy （group A,28 cases）,and conventional ileostomy （group B,26 cases）.Results The mean time for anus to restore defecation was identical in the two groups.The period of protection of the anastomosis,was 21 d （15 ～ 35 d） in group A.The rate of spontaneous closure of the stoma after removal of the tube was 100％.The stoma was reduced after 3 to 6 months in group B and major complication developed in one case in this group.Conclusions Temporary ileostomy prevents anastomotic leakage of anterior resection in patients of rectal carcinoma receiving preoperative neoadjuvant chemoradiotherapy.Intubation ileostomy is effective and safe in prevention of anastomotic leakage saving stoma reduction procedures.