预防性横结肠造瘘与末端回肠造瘘在直肠癌低位前切除术中应用比较

Preventive transverse colostomy versus terminal ileostomy in low anterior rectal cancer resection

目的:比较预防性横结肠造瘘与末端回肠造瘘应用于直肠癌低位前切除术的临床效果。方法:回顾分析79例低位直肠癌行保肛并预防性肠造瘘手术患者临床资料,其中预防性横结肠造瘘33例,预防性末端回肠造瘘46例。比较两组患者术后吻合口瘘、造瘘口相关并发症发生情况以及血清炎症因子水平。结果:两组患者术前资料具有可比性。横结肠造瘘组发生吻合口瘘2例(6.06%),末端回肠造瘘组4例(8.70%),两组间差异无统计学意义(P>0.05);横结肠造瘘组切口感染发生率高于末端回肠造瘘组(P<0.05),其他造瘘口相关并发症发生率两组间差异无统计学意义(均P>0.05);与术前两组血清C-RP及IL-6水平比较,差异无统计学意义(均P>0.05);横结肠造瘘组术后24、48、72 h血清C-RP及IL-6水平均明显高于末端回肠造瘘组(均P<0.05)。结论:低位直肠癌前切术中,采用预防性横结肠造瘘与预防性末端回肠造瘘在防止吻合口瘘方面效果相似,但末端回肠造瘘术在减轻术后创伤应激反应,减少并发症方面优于横结肠造瘘术。

Objective：To compare the clinical effects between preventive transverse colostomy and terminal ileostomy in low anterior rectal cancer resection.Methods：The clinical data of 79 patients with low rectal cancer undergoing low anus-preserving operation with preventive enterostomy were retrospectively analyzed.Of the patients,33 cases received preventive transverse colostomy,and 46 cases received preventive terminal ileostomy.Between the two groups of patients,the incidence of postoperative anastomotic leakage and stoma-related complications as well as the serum levels of inflammatory factors were compared.Results：The preoperative data of the two groups of patients were comparable.Anastomotic leakage occurred in 2 cases（6.06%） in transverse colostomy group,and in 4 cases（8.70%） in terminal ileostomy group,and the difference between the two groups had no statistical significance（P0.05）.The incidence of wound infection in in transverse colostomy group was higher than that in terminal ileostomy group（P0.05）,but the incidences of all other stoma-related complications showed no significant difference between the two groups（all P0.05）.The serum levels C-RP and IL-6 levels in transverse colostomy group at 24,48 and 72 h after operation were all higher than those in terminal ileostomy group（all P0.05）.Conclusion：Preventive transverse colostomy has similar effect as preventive terminal ileostomy in avoiding postoperative anastomotic leakage in low anterior rectal cancer resection,but terminal ileostomy is superior to transverse colostomy in terms of reducing postoperative trauma and stress responses,and complications.