两种预防性回肠造口开放方式对低位直肠癌手术效果

EFFECT OF TWO OPENING METHODS FOR PROPHYLACTIC ILEOSTOMY ON SURGICAL OUTCOME OF LOW RECTAL CANCER

目的探讨预防性回肠造口Ⅰ期开放和Ⅱ期开放方式对低位直肠癌病人术后恢复和免疫功能的影响。方法选择胃肠外科收治的低位直肠癌行腹腔镜直肠癌低位前切除术+预防性回肠末端造口术病人89例,随机分为Ⅰ期造口开放组(45例)和Ⅱ期造口开放组(44例)。观察并比较两组病人术后恢复情况、并发症、生活质量及免疫功能等。结果Ⅰ期造口开放组手术时间长于Ⅱ期造口开放组,差异有统计学意义(t=2.848,P<0.05);Ⅰ期造口开放组术后发热时间、术后住院时间以及住院费用明显低于Ⅱ期造口开放组,差异均有统计学意义(t=2.163~8.280,P<0.05);两组造口相关并发症、系统并发症发生率比较差异均无统计学意义(P>0.05);Ⅰ期造口开放组病人出院时生活质量评分高于Ⅱ期造口开放组,差异有统计学意义(t=5.402,P<0.05)。术后第3天Ⅰ期造口开放组病人IgA、IgG水平明显高于Ⅱ期造口开放组,差异有统计学意义(t=4.789~5.553,P<0.05);术后第7天Ⅰ期造口开放组CD4+、CD4+/CD8+和IgA、IgM、IgG均明显高于Ⅱ期造口开放组,差异有统计学意义(t=5.774~16.373,P<0.05);时间因素对免疫功能的影响不随造口开放方式的不同而改变(P>0.05)。结论预防性回肠造口Ⅰ期开放安全有效,可改善病人术后免疫功能,促进病人康复。

Objective To investigate the effect of stageⅠ opening versus stageⅡ opening of prophylactic ileostomy on postoperative recovery and immune function in patients with low rectal cancer.Methods A total of 89 patients with low rectal cancer who underwent laparoscopic low anterior resection of rectal cancer and prophylactic terminal ileostomy in Department of Gastrointestinal Surgery were enrolled and randomly divided into stage Ⅰ opening group with 45 patients and stage Ⅱ opening group with 44 patients.The two groups were compared in terms of postoperative recovery,complications,quality of life,and immune function.Results Compared with the stageⅡ opening group,the stageⅠ opening group had a significantly longer time of operation（t=2.848,P〈0.05）,as well as significantly shorter time to postoperative pyrexia and length of postoperative hospital stay and significantly lower hospital costs（t=2.163-8.280,P〈0.05）.There were no significant differences in the incidence rates of ileostomy-related complications and systemic complications between the two groups（P〈0.05）.The stage Ⅰ opening group had a significantly higher quality of life score at discharge than the stageⅡ opening group（t=5.402,P〈0.05）.On 3 dafter surgery,the stageⅠ opening group had significantly higher levels of IgA and IgG than the stageⅡ opening group（t=4.789-5.553,P〈0.05）;on 7 dafter surgery,the stageⅠ opening group had significantly higher percentage of CD4-＋,CD4-＋/CD8-＋ratio,and le-vels of IgA,IgM,and IgG than the stageⅡ opening group（t=5.774-16.373,P〈0.05）.The influence of time factor on immune function did not change with the opening method for ileostomy（P〈0.05）.Conclusion StageⅠ opening of prophylactic ileostomy is safe and effective and can improve patients＇ immune function and promote their recovery after surgery.