部分盲肠壁埋于皮下的改良盲肠造口在低位直肠癌保肛中的应用

Application of modified colostomy under subcutaneous placement of partial cecal wall in anterior resection for low rectal cancer

目的评估部分盲肠壁埋于皮下的改良盲肠造口在低位直肠癌全系膜切除术中的价值。方法回顾性分析2012年6月至2017年4月淄博市中心医院收治的低位直肠癌患者24例,均采用部分盲肠壁埋于皮下的改良盲肠造口术进行保肛治疗,分析所有患者术后切口感染、吻合口瘘发生情况、排便情况,并随访评估手术后的长期疗效。结果 24例发生切口感染2例;发生单纯吻合口瘘3例(包括长期服用激素者1例),经保守治疗治愈1例,开放造口治疗2例;发生直肠阴道瘘1例,经保守治愈。术后2周17例排便5~12次/d,7例≤4次/d;术后1个月均能预知和控制排便;术后3个月排便均≤4次/d;术后6个月22例排便1~3次/d,2例偶有粪便外溢。出院后随访6个月至3年,发生吻合口狭窄1例,局部复发2例,远处转移3例;死亡2例。结论在有吻合口瘘发生高危因素时,对比末端回肠预防性造口,部分盲肠壁埋于皮下的改良盲肠造口具有操作简单、创伤小、安全有效等优点。若术后复发引起梗阻,再次开放时更加简易。

Objective To evaluate the value of modified colostomy under subcutaneous placement of partial cecal wall in anterior resection for low rectal cancer. Methods A retrospective analysis of twenty -four patients with low rectal cancer admitted to Zibo Central Hospital from June 2012 to April 2017 was performed. Patients were treated with modified colostomy under subcutaneous placement of partial cecal wall in anterior resection for low rectal cancer. Postoperative incision infection, anastomotic fistula and defecation were analyzed to evaluate the value of this operation with long-term follow-up. Results There were 2 cases of incision infection; 3 cases of pure anastomotic fistula （including 1 case of long-term hormone taking）, of whom 1 case was cured with conservative treatment, 2 caes with open colostomy; 1 case with rectovaginal fistula who was cured by conservative treatment. Two weeks after surgery, 17 cases had defecation 5-12 times/d, 7 cases less than or equal to 4 times/d. One month after surgery, all patients could predict and control the defecation. Three months after surgery, defecation was less than 4 times/d. Six months after surgery, 22 cases had defecation 1-3 times/d, 2 cases with waste spills. The patients were followed up for 6 months to 3 years after discharge. Anastomotic stenosis occurred in 1 case, local recurrence in 2 cases, distant metastasis in 3 cases, and death in 2 cases. Conclusions The modified stoma has the advantages of simple operation, safety and effectiveness. If the postoperative recurrence leads to obstruction, it will be easier for reoperation again.