一针法预防性回肠造口在直肠癌低位前切除手术中的应用

Application of one-stitch preventive ileostomy in anterior resection of low rectal cancer

目的探讨一针法回肠造口方法在直肠癌低位前切除手术中的技术优势。方法前瞻性分析2016年1月至2019年1月河南省肿瘤医院普外科连续80例行直肠癌低位前切除并预防性回肠造口手术的患者,按随机表法分为一针法回肠造口组(观察组)和传统方法造口组(对照组),对比两组造口手术操作时间、造口皮肤黏膜分离、粪水性皮炎、造口旁疝、造口脱垂、造口回缩等相关造口并发症指标的发生率。结果两组患者的基线资料比较差异无统计学意义(均P>0.05),观察组手术操作时间短于对照组[(2.1±0.9)min vs.(15.2±4.6)min](t=-17.510,P<0.05),造口皮肤黏膜分离、粪水性皮炎、造口回缩等发生率与传统方法组比较差异均有统计学意义(观察组造口皮肤黏膜分离患者1例,对照组15例;观察组粪水性皮炎患者3例,对照组32例;观察组造口回缩患者0例,对照组8例)(χ^2=15.313,42.717,8.889;P均<0.05),在造口旁疝、造口脱垂两方面差异无统计学意义(观察组造口旁疝患者2例,对照组6例;观察组造口脱垂患者2例,对照组3例)(χ^2=2.222,0.213;P均>0.05)。结论一针法回肠造口在直肠癌低位前切除术中较传统方法更具操作优势,而且可减少相关造口并发症的发生。

Objective To explore the technical advantages of one-stitch preventive ileostomy in anterior resection for low rectal cancer.Methods The clinical data of 80 low rectal cancer patients undergoing anterior resection and ileostomy from January 2016 to January 2019 in the General Surgery Department of Henan Cancer Hospital were analyzed prospectively.And they were divided into one-stitch ileostomy group(observation group,n=40)and traditional transverse colostomy group(control group,n=40)according to the random table method.Statistical analysis was performed for the two groups.We compared the operation time and the morbidity of postoperative complications associated with colostomy such as mucocutaneous separation,fecal dermatitis,ileostomy hernia,ileostomy prolapse and ileostomy retraction Results There were no significant differences in baseline data between the two groups(all P>0.05).The operation time of observation group was shorter than that of control group[(2.1±0.9)min vs.(15.2±4.6)min](t=-17.510,P<0.05).Incidences of mucocutaneous separation,fecal dermatitis,ileostomy hernia were significantly lower in observation group(There was 1 case with mucocutaneous separation in the observation group and 15 cases in the control group;There were 3 cases with fecal dermatitis in the observation group and 32 cases in the control group;There were 0 case with ileostomy hernia in the observation group and 8 cases in the control group),(χ^2=15.313,42.717,8.889;all P<0.05).There was no significant difference in ileostomy prolapse and ileostomy retraction between the groups(There were 2 cases with ileostomy prolapse in the observation group and 6 cases in the control group;There were 2 cases with ileostomy retraction in the observation group and 3 cases in the control group),(χ^2=2.222,0.213;all P>0.05).Conclusion One-stitch preventive ileostomy in anterior resection for low rectal cancer have advantage of operation and can reduce postoperative complications associated with colostomy.