预防性回肠末端造瘘在腹腔镜直肠癌低位前切除术中的应用价值

The application of preventive terminal ileostomy in laparoscopic low anterior resection of rectal cancer

目的探讨预防性回肠末端造瘘在腹腔镜直肠癌低位前切除手术中的应用价值。方法依据是否接受预防性回肠末端造瘘,将242例接受腹腔镜直肠癌低位前切除术的直肠癌患者分为对照组(n=132)和观察组(n=110),观察组患者接受腹腔镜直肠癌低位前切除术+预防性回肠末端造瘘,对照组患者仅接受腹腔镜直肠癌低位前切除术。比较两组患者围手术期相关指标和术后恢复情况。结果两组患者吻合口瘘发生率、手术时间、术中出血量、住院时间、住院费用、淋巴结清扫数目比较,差异均无统计学意义(P﹥0.05)。此外,观察组出现吻合口瘘患者的住院时间明显短于对照组出现吻合口瘘的患者,住院费用也明显低于对照组出现吻合口瘘的患者,差异均有统计学意义(P﹤0.01)。观察组患者永久性造瘘发生率为0,明显低于对照组患者的7.6%,差异有统计学意义(P﹤0.01)。结论预防性回肠末端造瘘并不能降低腹腔镜直肠癌低位前切除术后吻合口瘘的发生率,但对具有吻合口瘘高危因素的患者,预防性回肠末端造瘘是一种理想的手术方法。

Objective To investigate the value of applying preventive terminal ileostomy in laparoscopic low anterior resection of rectal cancer.Method According to whether or not to receive preventive terminal ileostomy,242 patients with rectal cancer undergoing laparoscopic low anterior resection were divided into control group(n=132)and study group(n=110).Patients in the study group underwent laparoscopic low anterior resection+preventive terminal ileostomy,the control group only received laparoscopic low anterior resection.The perioperative indicators and postoperative recovery in the two groups were compared.Result There were no significant differences in regard to the incidence of anastomotic fistula,operative time,volume of intraoperative blood loss,duration of hospital stay,hospitalization expenses,and number of dissected lymph nodes between study group and control group(P>0.05).Additionally,the length of hospital stay among patients with anastomotic leakage in study group were significantly shorter than that of the control group,with less hospitalization cost,and the differences were of statistical significance(P<0.01).The rate of permanent ileostomy in study group patients was 0,which was significantly lower compared to the 7.6%in control group,the differences was statistically significant(P<0.01).Conclusion The preventive terminal ileostomy cannot reduce the incidence of anastomotic fistula after laparoscopic low anterior resection for rectal cancer,while it is an ideal alternative surgical option for patients with high risk of anastomotic fistula.