腹会阴联合切除术两种乙状结肠造口对比分析

The Contrastive Analysis of Two Kinds of Sigmoid Colostomy in Abdominal Perineal Resection

目的比较腹会阴联合切除术患者经腹膜内、外两种乙状结肠造口的临床结果。方法回顾性分析2010年3月至2014年3月期间内江市第二人民医院普外科172例行腹会阴联合切除术患者的临床资料。其中经腹膜内乙状结肠造口60例(经腹膜内组)、经腹膜外乙状结肠造口76例(经腹膜外组)及经腹膜外乙状结肠造口并功能锻炼36例(功能锻炼组)。对比3组患者的手术情况、术后并发症发生情况及造口功能。结果 1手术情况:3组患者在造口定位选择、手术时间、术中出血量及术后住院时间方面比较差异无统计学意义(P>0.05);经腹膜内组和功能锻炼组在术后首次排气和排便时间明显早于经腹膜外组,差异具有统计学意义(P<0.05)。2术后并发症:经腹膜外组和功能锻炼组的造口并发症发生率低于经腹膜内组,差异具有统计学意义(P<0.05);功能锻炼组又低于经腹膜外组,差异也具有统计学意义(P<0.05)。3造口功能:经腹膜外组排便信号出现时间>30 s者所占比例明显高于经腹膜内组,功能锻炼组又高于经腹膜外组,差异均具有统计学意义(P<0.05);经腹膜外组排便信号出现后自主控制排便到排出粪便时间>2 min者所占比例明显高于经腹膜内组,功能锻炼组又高于经腹膜外组,差异均具有统计学意义(P<0.05)。结论腹会阴联合切除术经腹膜外乙状结肠造口较经腹膜内造口术后造口相关并发症少,且控便、排便能力更好。术后功能锻炼能进一步减少造口相关并发症及改善造口功能。

Objective To contrastive the clinical results of intraperitoneal sigmoid colostomy and extraperitoneal sigmoid colostomy in abdominal perineal resection. Methods The clinical data of 172 patients who underwent abdominal perineal resection from March 2010 to March 2014 were retrospectively analyzed. Sixty cases were performed the intraperitoneal sigmoid colostomy（intraperitoneal group）, seventy-six cases were performed the extraperitoneal sigmoid colostomy（extraperitoneal group）, and thirty-six cases were performed the functional exercise after extraperitoneal sigmoid colostomy（functional exercise group）. The operation situation, postoperative complications, and colostomy function of three groups of patients were compared. Results 1 Operation situation： The colostomy location selection, operative time, intraoperative blood loss, and postoperative hospital stay of the three groups had no statistically significant differences（P〉0.05）. The postoperative first exhaust and defecate time of the intraperitoneal group and the functional exercise group were obviously earlier than the extraperitoneal group, the difference had statistical significance（P〈0.05）. 2 The postoperative complications： The postoperative complications rates of the extraperitoneal group and functional exercise group were lower than the intraperitoneal group, had statistically significant difference（P〈0.05）, the functional exercise group was lower than the extraperitoneal group, the difference had statistical significance（P〈0.05）. 3 The colostomy function： The patient＇proportion that 〉30 s of appeared time of defecation signals in the extraperitoneal group was significantly higher than the intraperitoneal group, and the functional exercise group was higher than that in the extraperitoneal group, the difference were statistically significant（P〈0.05）. The patient＇ proportion that 2 min of autonomous control of defecation to discharge feces time after the bowel signal appears in the extraperitoneal group was significantly higher than the intraperitoneal group, and the functional exercise group was higher than that in the extraperitoneal group, the difference were statistically significant（P〈0.05）. Conclusions The intraperitoneal sigmoid colostomy has less colostomy related complications than extraperitoneal sigmoid colostomy in abdominal perineal resection. The control, and defecate ability are better. Postoperative function exercise can further reduce the colostomy complications and improve the function of colostomy.