预防性造瘘在低位直肠癌根治术中的临床应用价值

Clinical application value of prophylactic ostomy in radical resection for patients with low rectal cancer

目的探讨预防性造瘘在低位直肠癌根治术中的临床应用价值。方法回顾性分析76例老年低位直肠癌患者的临床资料,所有患者均接受直肠癌前切除术,根据是否进行预防性造瘘分为观察组(n=40)和对照组(n=36),观察组患者进行预防性造瘘,对照组患者未进行预防性造瘘,比较两组患者的术后相关指标(首次排气时间、住院时间和住院费用),术前和术后7天外周血C反应蛋白(CRP)水平及淋巴细胞总数,术前和术后5天外周血降钙素原(PCT)水平,术后吻合口瘘发生率。结果观察组患者术后首次排气时间、住院时间均明显短于对照组,住院费用明显少于对照组,差异均有统计学意义(P﹤0.01)。术前,两组患者的外周血CRP、PCT水平及淋巴细胞总数比较,差异均无统计学意义(P﹥0.05)。观察组患者术后7天外周血CRP水平、术后5天外周血PCT水平均明显低于同时间点对照组患者,观察组患者术后7天外周血淋巴细胞总数明显多于同时间点对照组患者,差异均有统计学意义(P﹤0.01)。术后,观察组患者的吻合口瘘发生率低于对照组(P﹤0.05)。结论对于老年低位直肠癌患者,在低位直肠癌根治术中进行预防性造瘘可缩短术后首次排气时间和住院时间,减少住院费用和炎性反应,降低吻合口瘘的发生率,是一种更加安全的选择。

Objective To investigate the clinical value of prophylactic ostomy in radical resection for patients with low rectal cancer. Method The clinical data of 76 patients with low rectal cancer surgery were analyzed retrospectively. According to the presence or absence of prophylactic ostomy, patients were divided into observation group (n=40) and control group (n=36). The patients in observation group underwent prophylactic ostomy, while patients in the control group with no prophylactic ostomy. The postoperative indexes (time of first exhaust, duration of hospitalization and hospitalization expenses), the levels of peripheral blood C reactive protein (CRP) and total lymphocyte count before and at 7 days after the operation, the levels of peripheral blood procalcitonin (PCT) before and at 5 days after the operation and the incidences of postoperative anastomotic fistula in the two groups were compared. Result The time of first exhaust, duration of hospitalization and hospitalization cost in the observation group were significantly shorter or lower than those in the control group, and the difference was statistically significant (P<0.01). The peripheral blood levels of CRP at 7 days after operation and PCT at 5 days after operation of patients in the observation group were significantly lower than those of patients in the control group, and the total account of peripheral blood lymphocytes at 7 days after operation of patients in the observation group was significantly higher than that of patients in the control group at 7 days after operation (P<0.01). The incidence of postoperative anastomotic fistula in the observation group were significantly lower than that in the control group (P<0.05). Conclusion For elderly patients with low rectal cancer, prophylactic ostomy can shorten the time of first exhaust and duration of hospitalization, reduce hospitalization costs and reaction of inflammatory, and reduce the incidence of anastomotic fistula in radical resection of low rectal cancer, which is considered as a safer choice.