腹腔镜腹膜外与腹膜内结肠造口在Miles术中的临床对照研究

Clinical control study between laparoscopic extraperitoneal and intraperitoneal colostomy in Miles operation

目的探讨腹腔镜经腹会阴联合切除术(Miles术)行腹膜外隧道式结肠造口的安全性及可行性。方法对2014年9月至2017年5月川北医学院附属医院胃肠外科收治的98例低位直肠癌及肛管癌患者行腹腔镜Miles术中腹膜外隧道式结肠造口(腹膜外造口组,47例)和腹膜内结肠造口(腹膜内造口组,51例)患者的临床资料进行回顾性分析,观察两组患者造口并发症发生情况及造口时间。结果腹膜内造口组患者造口脱垂、感染、旁疝发生率均明显高于腹膜外造口组,造口时间明显长于腹膜外造口组,差异均有统计学意义(P<0.05);两组患者造口水肿、缺血及回缩发生率比较,差异均无统计学意义(P>0.05)。结论相对于腹膜内结肠造口,腹膜外隧道式结肠造口可明显降低Miles术后结肠造口并发症发生率,节约手术时间,但其远期并发症尚需进一步观察。

Objective To study the safety and feasibility of laparoscopic abdominoperineal resection（Miles surgery）for conducting extraperitoneal tunnel type colostomy. Methods The clinical data of 98 cases of low rectal cancer and anal ca-nal cancer in this hospital from September 2014 to May 2017 treated by laparoscopic Miles operation,including extraperitoneal tunnel type colostomy（extraperitoneal colostomy group,47 cases） and intraperitoneal colostomy（intraperitoneal colostomy group,51 cases）,were retrospectively analyzed. The occurrence situation of peristomial complications and stoma time were observed in the two groups. Results The incidence rates of stoma prolapse,infection and stoma hernia in the intraperitoneal colostomy group were significantly higher than those in the extraperitoneal colostomy group,and its stoma time was significantly longer than that of extraperitoneal colostomy,the differences between the two groups were statistically significant（P〈0.05）. There was no statistically significant difference in the occurrence rates of stoma edema,ischemia and retraction between the twogroups. Conclusion Compared with intraperitoneal colostomy,extraperitoneal tunnel type colostomy can significantly reduce the occurrence rate of colostomy complications after Miles operation,and saves the operation time. But its long term complica-tions need to be further observed.