预防性Y型造瘘在保护肠道高危吻合口中的临床应用

Clinical Application of Preventive Y-type Fistula in Protecting the High-risk Anastomosis of the Intestinal Tract

目的探讨预防性Y型造瘘在保护肠道高危吻合口中的临床应用效果。方法选取2015年1月至2018年7月昆明医科大学第二附属医院收治的各类有肠道高危吻合口,予行预防性造瘘术,并于术后择期行造口还纳术的100例患者,其中预防性Y型造瘘50例作为观察组,传统袢式造瘘50例作为对照组。比较2组术后住院天数、肠瘘发生率、术后肠功能恢复时间、二次手术还纳手术时间、还纳术中出血量及切口感染率。结果相比对照组,观察组二次还纳手术时平均手术时间明显缩短,术中出血量显著减少,术后肠功能恢复时间较短,住院天数短,差异有统计学意义(P<0.05)。2组患者术后吻合口瘘发生率、还纳术后切口感染率、一次手术术后住院天数、一次手术肠功能恢复时间、造瘘维持时间差异无统计学意义(P>0.05)。结论存在肠道高危吻合口患者行预防性Y型造瘘术可有效降低吻合口瘘的发生,造口还纳时更加简单易行,创伤小,恢复快,无再次肠瘘发生,有临床应用价值。

Objective To explore the clinical application effect of preventive Y-type fistula in protecting intestinal high-risk anastomosis. Methods A total of 100 patients who were admitted to the first ward of gastrointestinal surgery of the second affiliated hospital of kunming medical university from January 2015 to July 2018 were selected for temporary fistulas and elective ostomyafter operation, 50 cases of prophylactic Y type fistulas were selected as observation group,and 50 cases with conventional loop fistulas were selected as control group. The postoperative hospital stay, the incidence of intestinal fistula, the recovery time of postoperative intestinal function, the time of second operation for reinstatement, the amount of blood loss, the incidence of intestinal fistula and the infection rate of incision were compared between the two groups. Results Compared with the control group, the average operation time of the observation group was shorter during the second reinstatement surgery, with less intraoperative hemorrhage, shorter postoperative recovery time of intestinal function, shorter postoperative hospitalization days, and no intestinal fistula, with statistically significant difference (P<0.05).There were no statistically significant differences in the incidence of intestinal fistula, length of stay, duration of fistula repair, and wound infection rate between the two groups after the first operation (P>0.05).Conclusions Preventive Y-shaped enterostomy can effectively reduce the occurrence of anastomotic fistula in patients with high risk of intestinal anastomotic fistula. It has the advantages of shorter operation time, less bleeding during operation, shorter hospital stay after operation, less pain in secondary operation and no recurrence of intestinal fistula. It has good clinical value.