直肠癌手术中预防性末段回肠袢式造瘘的临床效果分析

Clinical effect of prophylactic terminal ileum stoma plate in rectal cancer operation

目的探讨预防性末段回肠袢式造瘘在部分直肠癌手术中的应用价值。方法回顾性分析2005年1月-2015年6月本院收治的82例高吻合口瘘风险的直肠癌前切除患者的临床资料,根据手术方式不同分为观察组和对照组,每组41例。观察组与对照组均行Ⅰ期根治切除吻合术,观察组术中同时行预防性末段回肠袢式造瘘。对比两组围手术期死亡率、术后并发症发生率。结果两组患者均无围手术期死亡;两组手术时间及术中出血量对比差异无统计学意义（P〉0.05）,观察组术后排气时间及术后进食时间明显早于对照组,两组间比较差异有统计学意义（P〈0.05）。对照组术后吻合口瘘6例,发生率为14.63%;观察组术后吻合口瘘1例,发生率为2.43%。观察组吻合口瘘发生率明显低于对照组（P〈0.05）;对照组其中4例吻合口瘘行二次手术永久性造瘘,观察组二次手术率低于对照组,差异有统计学意义（P〈0.05）;两组术后合并切口感染发生率及平均住院天数对比差异无统计学意义（P〉0.05）。结论对于合并吻合口瘘高危因素的直肠癌患者,预防性末段回肠袢式造瘘可明显降低吻合口瘘的发生。

Objective To explore the application value of prophylactic terminal ileum stoma plate in some rectal cancer operation. Methods 82 patients with anterior resection of rectal cancer patients with high risk anastomotic fistula in the ninety-first central hospital of PLA from Jan. 2005 to Jun. 2015 were divided into observation group and control group with 41 cases in each group according to the operation methods. All patients in the two groups underwent one stage radical resection and anastomosis operation, but the patients in observation group also underwent prophylactic terminal ileum stoma plate. Then the mortality rate and the postoperative complication rate were compared between the two groups. Results The mortality rate was zero in both groups, so there was no statistically significance between operation time and the amount of bleeding during operation（P〉0.05）. The postoperative exhaust time and feeding time in observation group obviously earlier than that of the control group. So the difference between the two groups was statistically significant（P〈0.05）. There were 6 cases of anastomotic leakage after operation in control group and the rate was 14.63%, while there was only 1 case in observation group with the rate of 2.43%, the difference was statistically significant（P〈0.05）. There were 4 cases of anastomotic leakage in control group given the second operation permanent stoma, the reoperation rate in observation group was lower than that of the control group（P〈0.05）.There were no statistically differences in the incidence rate of incision infection after operation and the mean hospital stay between the two groups（P〉0.05）. Conclusion For rectal cancer patients with high risk factors of anastomotic leakage, prophylactic terminal ileum stoma can significantly reduce the occurrence of anastomotic leakage.