腹腔镜低位直肠癌根治术预防性造口与无预防性造口临床对比研究

Clinical control study of defunctioning and non-defuncioning stoma in low anterior resection for rectal cancer

目的比较腹腔镜下低位直肠癌根治术无预防性造口与预防性造VI的临床资料及术后并发症的发生情况，探讨不行预防性造口的临床意义。方法回顾70例实施手术治疗的低位直肠癌患者的临床资料，根据手术方式分为无预防性造口组（28例）和预防性造口组（42例），采用SPSSl9．0统计软件比较两组患者术后并发症发生情况。结果预防性造口组和非预防性造口组术中手术时间、出血量、术后进食时间差异无统计学意义；预防性造口组术后留院时间明显延长（P〈0．05）；预防性造口组术后并发吻合口瘘2例，吻合口出血1例，肠梗阻2例，切口并发症2例，吻合口狭窄8例，造瘘口并发症7例，大便失禁1例，便频、便急2例，并发症发病率59．5％；非预防性造口组术后吻合口瘘1例，吻合口出血1例，肠梗阻1例，切口并发症1例，大便失禁1例，便频、便急1例，并发症发病率21．4％；预防性造口术后总体并发症发病率较非预防性造口高（P〈0．05），但吻合口瘘发病率差异无统计学意义（P〉0．05）。结论腹腔镜低位直肠癌根治术无适应证行预防性造口不能降低术后并发症的发生。

Objective To compare the clinical data and postoperative complications between defunctioning stoma and non-defunctioning stoma in laparoscopie low anterior resection for rectal carcinoma, and study the clinical significance of non-defunctioning stoma. Methods The clinical data of 70 cases who accepted laparoscopie low anterior resection was collected. According to the operative methods, all patients were divided into two groups, defu ctioning stoma group included 42 cases and non-defunctioning stoma group induded 28 cases. The situation of postoper rative complications of patients boh two groups were compared by SPSS 19.0. Results The operation time, bleeding volume, eating time in defunctioning stoma groups and non-defunctioning stoma groups were no statistical significant. The time staying in hospital in defunctioning stoma groups was longer than that of non- defunctioning stoma groups （P 〈 0.05）. dcfunetioning stoma groups, anastomotic leakages happened in 2 case, anastomotic hemorrhage in 1 case, incision complications in 2 cases, anastomotic strictures in 8 cases, stoma complications in 1 case. The total morbidity was 28.5%. In non-defunctioning stoma group anastomotic leakages happened in 1 case, anastomotic hemorrhage happened in 1 case, incision complications happened in 1 case, internal complications happened in 1 case. The postoperative morbidity was 17.8%. The total complications had significant difference in the two groups（P 〈0.05）. The anastomotic leakage and hemorrhage in two groups had no difference significantly. Conclusion Defunctioning stoma with no indication can not decrease the complication in laparoscopie low anterior resection for rectal cancer case.