腹膜外结肠造口在直肠癌Miles术中的临床应用

Clinical application of extraperitoneal sigmoidostomy in Miles operation for rectal cancer

目的探讨腹膜外结肠造口在直肠癌Miles术中的临床应用价值。方法 2008年1月至2013年6月我科完成Miles术96例。按结肠造口方式不同分为腹膜外造口组和腹膜内造口组,其中腹膜外造口组51例,腹膜内造口组45例。比较2组患者临床资料、造口并发症和排便功能。结果 2组患者造口狭窄、回缩、坏死、黏膜脱垂的发生率基本一致,差异无统计学意义(P>0.05)。造口旁疝的发生率腹膜内造口组多于腹膜外造口组(1.9%vs.17.8%,P<0.05)。腹膜外造口组术后排便控制能力好于腹膜内造口组。结论腹膜外结肠造口术可降低Miles术后造口并发症发生率,术后排便控制功能较好,可提高患者术后的生存质量。

Objective To explore the clinical value of extraperitoneal sigmoidostomy in Miles operation for rectal cancer. Methods 96 patients with rectal cancer undergoing Miles operation during January 2008 to June 2013 were divided into two groups according to different way of sigmoidostomy：the extraperitoneal group and the intraperitoneal sigmoidostomy group. The clinical data, complications caused by sig-moidostomy and defecation function were compared between the two grougs. Results 51 patients received extraperitoneal sigmoidostomy and 45 patients received intraperitoneal sigmoidostomy. There was no significant difference between the two groups in stenosis, retraction, necro-sis and prolapse of mucosa caused by sigmoidostomy. The incidence of parastomal hernia was higher in intraperitoneal sigmoidostomy group than that in extraperitoneal group （1. 9% vs 17. 8%,P〈0. 05）. The defecation function was better in extraperitoneal sigmoidostomy group. Conclusion The extraperitoneal sigmoidostomy has the advantages of less complications and better defecation functions, and it can effective-ly improve the life quality of patients.