选择性预防末端回肠造瘘在腹腔镜低位直肠癌保肛手术中的应用价值

Application of selective and preventive terminal ileostomy in laparoscopic radical resection of the low rectal cancer with preservation of anus

目的:探讨选择性预防末端回肠造瘘在腹腔镜低位直肠癌保肛术中对降低吻合口漏发生率的临床价值。方法:回顾分析为109例患者行腹腔镜低位直肠癌保肛手术的临床资料,其中40例行预防性末端回肠造瘘术,69例未行末端回肠造瘘术,对比两组患者术后情况。结果:造瘘组术后无一例发生吻合漏,术后肛门排气时间平均(1.3±0.4)d,术后进食时间平均(1.8±0.4)d,术后盆腔引流管拔除时间平均(6.2±1.5)d,术后平均住院(8.0±1.5)d,治疗费用平均(3.2±0.3)万元。未造瘘组患者术后9例(13.0%)发生吻合口漏,术后肛门排气时间平均(5.1±0.6)d,术后进食时间平均(5.7±0.3)d,术后盆腔引流管拔除时间平均(8.3±3.8)d,术后平均住院(14.2±3.6)d;治疗费用平均(4.3±0.8)万元。两组术后观察指标差异均有统计学意义。结论:低位直肠癌保肛术中选择性预防末端回肠造瘘可有效降低吻合口漏的发生率,尤其高龄、全身情况较差等不利于低位吻合的患者。但术者应进行个体化选择,同时严格遵循无瘤原则、合理选择病例、精细操作可使更多的低位直肠癌患者获得保留肛门的机会。

Objective：To investigate the value of selective and preventive terminal ileostomy for decrease of anastomotic leakage in laparoscopic radical resection of the low rectal cancer with preservation of anus. Methods：The clinical data of 109 patients of rectal cancer,who accepted low anterior resection with preservation of anus were retrospectively analyzed. 40 patients who received preventive terminal ileostomy were in the ileostomy group,and 69 patients who did not receive preventive terminal ileostomy were in the non-ileostomy group. The postoperation of the 2 groups were compared. Results：The incidence of anastomotic leakage,time to first flatus,time to liquid diet intake,time of pelvic drainage tube removal,duration of hospital stay,treatment costs were 0,（1. 3 ± 0. 4） d,（1.8 ±0.4） d,（6.2 ±1.5） d,（8.0 ±1.5） d,（3.2 ±0.3） ×10^4yuan in the ileostomy group,and 13. 0%,（5. 1 ± 0. 6） d,（5. 7 ±0. 3） d,（8. 3 ± 3. 8） d,（14. 2 ± 3. 6） d,（4. 3 ± 0. 8） × 10^4 yuan in the non-ileostomy group,with significant differences between the 2groups. Conclusions：Selective and preventive terminal ileostomy in laparoscopic radical resection of the low rectal cancer with preservation of anus can effectively reduce the incidence of anastomotic leakage,especially for the patients with old age,poor general condition who are not suitable for low anastomosis. Surgeons should make individual choice,strictly follow no-tumor principle,reasonably choose patients and carefully operate so that more patients with low rectal cancer can reserve their anuses.