免回纳回肠造口在腹腔镜Dixon手术中应用的可行性研究

The feasibility study of the non-return ileum in laparoscopic Dixon

目的:探讨免回纳回肠造口在腹腔镜直肠癌根治术(Dixon)中的临床应用价值。方法:采用回顾分析的研究方法,观察对比并分析免回纳回肠造口组(A组)和襻式回肠造口组(B组)两种术式的手术时间、通气通便时间、住院时间及费用、切口感染、术后肠梗阻、吻合口瘘、吻合口狭窄、造口相关并发症及二次回纳率等指标。结果:A组平均通气时间(4.40±0.87)d迟于B组(3.92±1.12)d(P<0.05)。A组平均通便时间(5.42±1.11)d迟于B组(3.55±0.93)d(P<0.05)。A组平均住院费用(50 997.31±5 336.85)元显著少于B组(58 860.14±2 288.13)元(P<0.05)。A组术后吻合口狭窄率、造口并发症发生率、术后二次回纳率(5.26%、5.26%、15.78%)均低于B组(22.5%、22.5%、75.00%)(均P<0.05)。结论:免回纳回肠造口相对于襻式回肠造口预防吻合口瘘中在手术时长等方面效果相当,并且具有术后吻合口狭窄率和二次回纳率更低、造口相关并发症更少、住院费用更少等优点。本术式安全可行且有良好的经济效益。

Objective:This paper discussed the clinical application value of the non-return ileum in laparoscopic Dixon.Methods:Using retrospective analysis of research methods,the patients were randomly divided into two groups,one of them accepted non-return ileumy(group A,the experimental group)and the other accepted loop ileostomy(group B,the control group).We analysisd the surgical operation time,aeration time,purge time,length of hospital stay,hospital expenses,incisional infection rate,incidence of intestinal obstruction after surgery,incidence of anastomotic fistula,incidence of anastomotic stenosis,colostomy related complications,secondary back pay rate and other indicators of the two groups.Results:The mean aeration time of group A[(4.40±0.87)d]was later than the average aeration time of group B[(3.92±1.12)d](P<0.05).The anus exhaust defecation time of group A[(5.42±1.11)d]was later than the average of group B[(3.55±0.93)d](P<0.05).The average hospitalization cost[(50997.331±5336.85)yuan]of group A was lower than group B[(58860.14±2288.13)yuan](P<0.05).The anastomotic stenosis rate,the incidence rate of complications,the secondary rate(5.26%,5.26%,15.78%)of group A were lower than that in group B(22.5%,22.5%,75.00%)(P<0.05).Conclusion:Compared with loop ileostomy,the incidence of non-return ileumy’s anastomotic stenosis,fistula related complications and secondary operation rate is lower.The cost of hospitalization is less.It is A safe and feasible surgical method with good economic benefit.