保护性回肠造口在直肠癌全直肠系膜切除术中的应用价值

Application value of protective ileostomy in total mesorectal excision for rectal cancer

目的探讨在直肠癌全直肠系膜切除术(TME)患者中,保护性回肠造口是否可以降低吻合口漏的发生率。方法回顾性分析2016年1月—2018年1月211例在南充市中心医院行腹腔镜下直肠癌全直肠系膜切除术患者的临床资料,其中保护性末端回肠造口患者48例(造口组),未实施保护性末端回肠造口患者163例(未造口组),统计两组吻合口漏的发生率。结果 211例患者术后发生吻合口漏7例,总的吻合口漏发生率为3.3%,其中造口组发生吻合口漏1例(2.1%),未造口组发生吻合口漏6例(3.7%)。两组差异无统计学意义(P>0.05)。结论在直肠癌全直肠系膜切除术患者中联合保护性末端回肠造口不能降低术后吻合口漏的发生率,但是能够减轻局部及全身症状,减少二次手术的发生率。

Objective To investigate whether protective ileostomy can reduce the incidence of anastomotic leakage in patients undergoing total mesorectal excision(TME). Methods A retrospective controlled study was conducted with the clinical data of 211 patients underwent laparoscopic TME of rectal cancer in author's hospital from January 2016 to January 2018,including 48 patients with protective terminal ileostomy(stoma group) and 163 patients without protective terminal ileostomy (non-stoma group). The incidence of anastomotic leakage in the two groups was analyzed. Results There were 7 cases of anastomotic leakage in 211 patients,the total incidence of anastomotic leakage was 3.3%. One case(2.1%) had anastomotic leakage in stoma group and 6 cases(3.7%) had anastomotic leakage in non-stoma group. The difference between the two groups was not statistically significant(P> 0.05). Conclusion Protective terminal ileostomy can not reduce the incidence of anastomotic leakage,but can alleviate local and systemic symptoms and reduce possibility of performing secondary surgery on patients.