预防性回肠造口在低位直肠癌保肛手术中的应用

Application of Preventive Ileostomy in Anus-preserving Operation for Low Rectal Cancer

目的研究预防性回肠造口在低位直肠癌保肛术中对降低吻合口漏发生率的应用价值。方法回顾分析80例患者行腹腔镜低位直肠癌保肛手术的临床资料,其中治疗组40例(Ⅰ组)行预防性造口术,对照组40例(Ⅱ组)未行预防性造口术,比较两组患者术后吻合口瘘等情况。结果造口组术后1例(2.5%)发生吻合口漏,术后肛门排气时间平均(1.4±0.5)d,术后进食时间平均(2.3±0.3)d,术后住院平均(8.1±0.5)d,治疗费用平均(4.5±1.2)万元。未造瘘组患者术后2例(5%)发生吻合口漏,术后肛门排气时间平均(4.2±0.3)d,术后进食时间平均(5.2±0.6)d,术后住院平均(11.4±0.8)d;治疗费用平均(4.6±1.8)万元。两组术后观察指标肛门排气时间、术后进食时间、平均住院日3项指标差异有统计学意义,而吻合口漏、平均住院费用差异无统计学意义。结论低位直肠癌保肛术中预防性末端回肠造口并不能降低吻合口漏的发生率,但可减少吻合口瘘出现后的感染症状,对于高龄、全身情况较差、放疗等不利于愈合的低位吻合患者,可选择预防性造口,以提高低位直肠癌的保肛率。

Objective To explore the application value of preventive ileostomy in anus-preserving operation for low rectal cancer in reducing the incidence of anastomotic leakage. Methods 80 cases treated with laparoscopic anus-preserving operation for low rectal cancer were retrospectively analyzed. The 40 patients in thetreatment group(Group I) were given preventive ileostomy,while the other 40 cases in the control group (Group II) were not. Postoperative anastomotic leakage of the two groups was compared. Results In the treatment group,one case of anastomotic leakage occurred (2.5%),the mean anal exsufflation time after operation was (1.4±0.5)d,the mean eating time after operation was (2.3±0.3)d,the mean duration of hospital stay was (8.1±0.5)d,and the mean treatment cost was (45±12) thousand yuan. In the control group,two cases of anastomotic leakage occurred (5%),the mean anal exsufflation time after operation was (4.2±0.3)d,the mean eating time after operation was (5.2±0.6)d,the mean duration of hospital stay was (11.4±0.8)d,and the mean treatment cost was (46±18) thousand yuan. There was statistically significant difference in the anal exsufflation time,eating time after operation,and mean duration of hospital stay between the two groups,but there was no statistically significant difference in the incidence of anastomotic leakage and mean treatment cost. Conclusion The preventive ileostomy in anus-preserving operation for low rectal cancer cannot reduce the incidence of anastomotic leakage,but it can reduce the infection symptoms after anastomotic leakage,which is suitable for the patients with factors not conductive to healing,such as advanced age,poor general condition and radiotherapy,to improve the rate of anal preservation in low rectal cancer.