腹膜外结肠造口在直肠癌Miles术中的应用效果

Effect of Extraperitoneal Colostomy in Miles Operation for Rectum Carcinoma

目的探讨腹膜外结肠造口在Miles术中的应用效果。方法选择2012年3月至2015年5月在南通市肿瘤医院行Miles术的直肠癌患者106例为研究对象,采用随机数字法分为腹膜外造口组(腹膜外组)和腹膜内造口组(腹膜内组),各53例,比较两组造口手术时间、首次排气时间、首次排便时间、近远期并发症发生情况及生存质量。结果腹膜外组与腹膜内组造口时间、首次排气时间、首次排便时间、住院时间及近期并发症发生率[(22.8±2.4)min比(16.4±1.5)min、(3.3±0.8)d比(3.9±1.4)d、(4.1±1.2)d比(4.4±1.1)d、(8.6±1.8)d比(10.3±2.3)d,15.1%(8/53)比20.8%(11/53)]比较差异无统计学意义(P>0.05);腹膜外组患者远期并发症发生率低于腹膜内组[0%(0/53)比15.1%(8/53)],术后12个月ADL量表评分显著低于腹膜内组[(15.3±2.1)分比(31.8±3.8)分](P<0.05)。结论与腹膜内造口相比,腹膜外结肠造口能有效降低Miles术远期并发症发生率,改善患者的生存质量。

Objective To explore the effect of extraperitoneal colostomy in Miles operation for rectum carcinoma.Methods A total of 106 patients with rectum carcinoma receiving Miles operation in Nantong Tumor Hospital from Mar.2012 to May 2015 were included in the study,and were divided into an extraperitoneal colostomy group（extraperitoneal group） and an intraperitoneal colostomy group（intraperitoneal group）,53 cases each,and the colostomy surgery time,first exhaust time,first defecation time,short-term and long-term complications and survival quality of the two groups were compared.Results The colostomy time,the first exhaust time,the first defecation time,the hospital stay time,recent complication rate of the extraperitoneat group and intraperitoned group had no statistically significant differences[（22.8±2.4） min vs（16.4±1.5） min,（3.3±0.8） d vs（3.9±1.4） d,（4.1±1.2） d vs（4.4±1.1） d,（8.6±1.8） d vs（10.3 ±2.3） d,15.1%（0/53） vs 20.8%（11/53） ]（P〉0.05）.The long-term complication incidence of the extraperitoneal group was significantly lower than that of the intraperitoneal group[0%（0/53） vs 15.1%（8/53） ],ADL scale score at the time of 12 month after operation of extraperitoneal group was significantly lower than that of the intraperitoneal group[（15.3±2.1） vs（31.8±3.8） ]（P〈0.05）.Conclusion Compared with intraperitoneal colostomy,extraperitoneal colostomy can effectively reduce long-term complications of Miles operation,and improve the quality of life of patients.