预防性回肠造瘘术在直肠癌根治术中的临床应用

Clinical Application of Preventive Ileostomy in Radical Resection for Colorectal Cancer

目的探讨预防性回肠造瘘术在直肠癌前切除术中的临床应用价值。方法对2010年1月到2014年11月收治的692例行直肠癌前切除术患者的临床资料进行回顾性分析,并对吻合口瘘的发生率、二次手术发生率及术后感染和住院时间进行对比分析。结果 185例行预防性回肠造瘘术的患者中有15例发生吻合口瘘;507例未行预防性回肠造瘘术的患者中发生吻合口瘘11例。造瘘组患者的二次手术、平均住院时间及术后感染率均明显低于未造瘘组,差异有统计学意义(P<0.05)。结论对存在高危因素的直肠癌患者行切除术的同时行预防性回肠造瘘术虽然未能降低吻合口瘘发生率,但增加了手术安全性,降低了医疗风险和二次手术率及术后感染率,缩短了住院时间。

Objective To investigate the clinical application of preventive ileostomy in radical resection for colorectal cancer. Methods Clinical data of 692 patients with rectal cancer were retrospectively analyzed, and the incidence rate of anasto- motic leakage, the incidence rate of the second operation and postoperative infection and hospitalization time were compared and analyzed. Results 15 patients had anastomotic leak in 185 patients treated with preventive ileostomy,ll patients had anastomotic leak in 507 patients without preventive ileostomy. Second operation, average hospitalization time and postoperative infection rate of stoma fistula group were lower than those of no stoma fistula group, the difference had statistical significance （P 〈 0.05 ）. Conclusion Preventive ileostomy in radical resection for colorectal cancer do not reduce anastomotic fistula, but it can increase surgical safety, reduce medical risk, second operation rate and postoperative infection rate, with shorter length of hospital stay.