结肠造口和回肠袢式造口术对老年梗阻性乙状结肠癌的疗效对比

Comparison of Efficacy of Colostomy and Loop Ileostomy Surgery for Elderly Obstructive Sigmoid Colon Cancer

目的探讨结肠造口术和回肠袢式造口术治疗老年梗阻性乙状结肠癌的疗效。方法选取老年乙状结肠癌患者80例,以随机数字法分为结肠造口组和回肠袢式造口组,每组40例。观察2组患者Ⅰ期和Ⅱ期手术的手术时间,术后排气时间,禁食时间,住院时间,术后肠造口回缩、坏死、水肿、脱垂并发症发生率等指标。随访2年,观察2组患者的死亡率和复发率。结果回肠袢式造口组患者Ⅰ期术后排气时间、禁食时间和住院时间均显著短于结肠造口组患者,差异有统计学意义(P<0.05)。Ⅰ期术后,2组患者的术后造口回缩、坏死、水肿、脱垂等并发症发生率无显著差异(P>0.05)。回肠袢式造口组患者Ⅱ期手术时间、排气时间、禁食时间和住院时间均显著短于结肠造口组患者,差异有统计学意义(P<0.05)。Ⅱ期术后,结肠造口组患者低血钾症的发生率明显高于回肠袢式造口组患者(P<0.05)。2组患者1年、2年死亡率和1年、2年复发率之间差异无统计学意义(P>0.05)。结论回肠袢式造口术用于老年乙状结肠癌患者的治疗与结肠造口术有相当的疗效,但是回肠袢式造口术更利于患者术后肠道功能的恢复。

Objective To investigate the efficacy of colostomy and loop ileostomy surgery for elderly patients with obstructive sigmoid colon cancer.Methods 80 cases of elderly sigmoid node cancer patients were randomly divided into colon stoma group and ileal loop colostomy group,each with 40 cases.Operation time,postoperative exhaust time,fasting time,hospitalization time,postoperative intestinal stoma retraction,necrosis,edema,prolapse complication rate and other indicators of stage Ⅰ andⅡ operation were observed.Followed up for 2 years,the mortality and recurrence rates of the 2 groups were observed.Results The postoperative exhaust time,fasting time and hospital stay in patients after stage Ⅰ operation of ileal loop colostomy group were significantly shorter than colon stoma group（P〈0.05）.There were no significant difference in postoperative stoma retraction,necrosis,edema and prolapse of the 2 groups（P〉0.05） after stage Ⅰ operation.The postoperative exhaust time,fasting time and hospital stay in patients after stage Ⅱ operation of ileal loop colostomy group were significantly shorter than colon stoma group（P〈0.05）.After stage Ⅱ surgery,colostomy patients hypokalemia incidence was significantly higher than loop ileostomy group（P〈0.05）.There were no significant difference between the 2 groups in 1-,2-year mortality and recurrence rates（P〉0.05）.Conclusion Loop ileostomy surgery for elderly sigmoid colon cancer treated have equivalent efficacy with colostomy,but it is more beneficial to the recovery of intestinal function.