三针法预防性横结肠造口在直肠癌前切除手术中的应用

Application of three-stitch preventive transverse colostomy in anterior resection of low rectal cancer

目的探讨三针法预防性横结肠造口方法在直肠癌低位前切除手术中的应用。方法前瞻性纳入2015年5月至2016年3月间河南省肿瘤医院普通外科连续收治的拟行直肠癌低位前切除并预防性横结肠造口手术的70例患者，按随机数字表法分为三针法横结肠造口组（35例）和传统横结肠造口组（35例）。三针法造口：首先自内侧切口皮肤上中1／3交汇处在距皮0．5-1．0cm处7号丝线缝合一针，自切口外侧进针，内侧出针，连缝针带线穿过横结肠边缘处的系膜无血管区；然后在切口外侧皮肤中上1／3交汇处再缝合一针，内侧进针外侧出针，再由无血管区穿至对侧；最后在造口上下两端各将横结肠浆肌层与皮肤缝合一针固定。比较两组患者造口手术操作时间以及术后相关造口并发症的发生率。结果两组患者基线资料比较，差异均无统计学意义（均P〉0．05）。三针法造口组造口时间较传统造口明显缩短[（3．2±1．3）min比（15．5±3．4）min，P〈0．05]，术后造口皮肤黏膜分离、皮炎和造口回缩的发生率显著低于传统造口组[分别为5．7％（2／35）比34-3％（12／35），P=0．007；8．6％（3／35）比31．4％（11／35），P=0．036；0比17．1％（6／35），P=0．025]，而造口脱垂和造口旁疝发生率的差异两组则无统计学意义（均P〉0．05）。结论三针法预防性结横结肠造口在直肠癌低位前切除中较传统横结肠造口方法更具操作优势，且可显著减少术后造口相关并发症。

Objective To explore the application of three-stitch preventive transverse colostomy in anterior resection of low rectal cancer. Method From May 2015 to March 2016, 70 consecutive low rectal cancer patients undergoing anterior resection and preventive transverse colostomy in our department were recruited in this prospective study. According to the random number table method, 70 patients were divided into three-stitch transverse colostomy group （observation group, n = 35） and traditional transverse colostomy group （control group, n = 35）. Procedure of three-stitch preventive transverse colostomy was as follows： firstly, at the upper 1/3 incision 0.5-1.0 cm distance from the skin, 7# silk was used to suture from outside to inside, then the needle belt line went through the transverse edge of the mesangial avascular zone. At the lower 1/3 incision 0.5-1.0 cm distance from the skin, 7# silk was used to suture from inside to outside, then silk went through the transverse edge of the mesangial avascular zone again and was ligatured. Finally, in the upper and lower ends of the stoma, 7# silk was used to suture and fix transverse seromuscular layer and the skin. The operation time and morbidity of postoperative complications associated with colostomy were compared between two groups. Results There were no significant differences in baseline data between the two groups （all P 〉0.05 ）. The operative time of observation group was shorter than that of control group [ （3.2 ± 1.3） min vs. （15.5 ± 3.4） rain, P 〈 0.05 ]. Incidences of colostomy skin-mucous separation, dermatitis, stoma rebound were significantly lower in observation group [5.7%（2/35） vs. 34.3%（12/35）, P = 0.007; 8.6%（3/35） vs. 31.4% （11/35）, P = 0.036 ; 0 vs. 17.1% （6/35）, P = 0.025, respectively], while incidences of parastomal hernia and stoma prolapse in two groups were similar （both P 〉 0.05）. Conclusion Compared with traditional transverse colostomy method, the three-stitch preventive transverse colostomy has more operating advantages and can reduce postoperative complications associated with colostomy.