中低位直肠癌前切除术两种预防性回肠造口方式的对比研究

Contrastive study between two types of protective ileostomy in middle-low anterior resection for rectal carcinoma

目的探讨并建立一种简单、安全、并发症少、容易制作且还纳的预防性回肠造口方法,从而避免中低位直肠癌前切除术后吻合口瘘的发生。方法回顾性分析广东省中医院2013年1月-2015年12月收治的行中低位直肠癌前切除后预防性造口50例患者的临床资料。其中,采用纵切单层缝合法27例,采用横切分层缝合法23例。观察两组患者的造口手术时间、术后恢复时间、术后造口相关并发症以及造口回纳手术时间、出血量的差异。结果两组患者均顺利完成手术,在术后恢复时间及术后造口相关并发症方面差异无统计学意义(P>0.05),但纵切单层缝合组较横切分层缝合组在造口手术时间、造口回纳手术时间和造口回纳手术出血量方面均显著减少(P<0.05),费用更加低廉。结论纵切单层缝合法是一种制作简易、安全性好、粪便转流彻底、并发症少、易于护理、易于还纳的造口方式。

Objective To discuss and establish a simple, safe, less complication, convenient operative and apothesis way in protective ileostomy and to prevent anastomotic leakage happening in middle-low anterior resection for rectal carcinoma. Methods Clinical materials of 50 patients who received protective ileostomy after middle-low anterior resection for rectal carcinoma from Jan. 2013 to Dec. 2015 were retrospectively analyzed. Of which, 27 patients were sutured by longitudinal single-layer and the others were transverse muhi-layer sutured. The indexes such as operation time, recovery time, complication with ileostomy, close stoma time and amount of bleeding were compared. Results All of the patients received protective ileostomy. There were no significant difference between the two groups in recovery time and complications with ileostomy （P 〉0.05）. However, the operation time, close stoma time and amount of bleeding in the longitudinal single-layer suture group were significantly lower than that of the transverse multi-layer suture group （P 〈 0.05）, also the former suture style was lower cost. Conclusions The way of longitudinal single-layer suture is a simple, safe, drastically divert the fecal stream, less complication, easy nursing and close stoma style of protective ileostomy.