手助腹腔镜腹膜外造瘘联合盆底腹膜重建的研究

Research of hand-assisted laparoscopic extraperitoneal colostomy combined with pelvic peritoneal reconstruction

目的探讨腹膜外造瘘联合盆底腹膜重建在手助腹腔镜直肠癌根治术中的应用价值。方法选取2013年6月至2014年10月在该院限期行手助腹腔镜下经腹联合会阴直肠癌根治术的直肠癌患者65例,按住院号单双数分为观察组(35例)和对照组(30例)。观察组患者施行腹膜外隧道式造瘘联合盆底腹膜关闭,对照组患者施行腹膜内造瘘未关闭盆底腹膜。分析比较两组患者在并发症和排便功能上的差异。结果观察组患者造瘘口旁疝、远期造瘘口总并发症发生率显著低于对照组,有排便感人数、大便成形人数多于对照组,而大便次数明显增加的人数少于对照组,差异均有统计学意义(P<0.05)。结论手助腹腔镜腹膜外造瘘联合盆底腹膜重建可以减少造瘘口并发症,提高患者生活质量。

Objective To explore the application value of extraperitoneal colostomy combined with pelvic peritoneal reconstruction in the hand-assisted laparoscopic radical resection of rectal carcinoma. Methods Totally 65 cases of rectal cancer undergoing hand-assisted laparoscopic transabdominal-perineal radical resection of rectal carcinoma within a definite time were selected and divided into the observation group （35 cases） and control group （30 cases） according to the odd and even number of admission. The observation group was performed the extraperitoneal tunnel-type colostomy combined with pelvic floor peritoneal closure ,while the control group was performed the intraperitoneal colostomy without pelvic peritoneal closure. The differences in postoperative complications and defecation function were analyzed and compared between the two groups. Results The total occurrence rate of complications such as parastomal hernia and long term stoma in the observation group was significantly lower than that in the control group, the cases number of having defecation feeling and stool forming in the observation group was more than that in the control group, while the cases number of defecation frequency obvious increase was less than that in the control group, and the differences were statistically significant（P〈0.05）. Conclusion Hand-assisted laparoscopic extraperitoneal colostomy combined with pelvic peritoneal reconstruction may reduce the stoma1 complications and improve the life quality of patients.