末端回肠悬吊术在腹腔镜下低位直肠癌根治术中的应用

Application of terminal ileum suspension in laparoscopic radical resection for low-rectal cancer

目的探讨末端回肠悬吊术在腹腔镜下低位直肠癌根治术(Dixon术)中的临床应用价值。方法选取2015年9月至2017年9月无锡市第三人民医院诊断为低位直肠癌患者40例,随机分为两组:回肠悬吊组和回肠造口组,每组各20例。两组患者均采用全直肠系膜切除术(TME)技术,行腹腔镜下直肠癌根治术(Dixon),回肠悬吊组予以加做末端回肠悬吊术(用乳胶管穿过末端回肠系膜,并将乳胶管拖出腹腔,固定于腹壁;如出现吻合口瘘,牵引乳胶管,将回肠拖出腹壁,行回肠袢式造口术),回肠造口组予以加做回肠袢式造口术。两组患者记录术后首次排气时间、术后住院时间、术后不适症状(腹泻、腹痛、腹胀、排便失禁)及术后并发症(造口出血(回肠悬吊组因吻合口瘘行回肠袢式造口),尿潴留,性功能障碍、吻合口瘘)发生率。结果回肠悬吊组术后首次排气时间延长,而其术后出现腹泻,因吻合口瘘重置回肠造口而导致的造口出血的发生率低,且行造口回纳术的发生率低,与回肠造口组相比存在统计学差异(P <0.05);而回肠悬吊组其吻合口瘘发生率、住院时间,与回肠造口组差异无统计学意义(P> 0.05)。结论末端回肠悬吊术可达到回肠造口的临床效果,且能够减少术后相关并发症(腹泻、造口出血等)的发生,同时不影响患者术后恢复,能有效减少造口还纳手术率,减轻病人痛苦及经济负担。

Objective To discuss the clinical application of terminal ileum suspension in laparoscopic radical resection for low-rectal cancer.Methods Between September 2015 to September 2017,forty patients with low-rectal cancer were randomly assigned to control group receiving laparoscopic radical proctectomy with total mesorectal excision(TME)combined with the terminal ileal loop ostomy(n = 20)and test group receiving laparo-scopic radical proctectomy with TME combined with terminal ileum suspension(n = 20). The first exhaust time,postoperative hospital stay,postoperative discomforts and complications were recorded.Results There were statistical differences between the two groups at the first exhaust time,post-operation diarrhea,colostomy bleeding and the rate of colostomy back operation(P < 0.05). Compared to the control group,there were no statistical differences at the rate of anastomotic fistula and postoperative hospital stay(P > 0.05).Conclusions Terminal ileum suspension could achieve the clinical effect of the ileostomy and significantly decrease post-operation complications. It does not affect the patient’s postoperative recovery and reduces the pain and financial burden of patients.