部分横结肠皮下潜行(预造口)在腹腔镜低位直肠癌前切除术中的应用

Application of placing transverse colon underneath the skin for preparing of colostomy in laparoscopic anterior resection of low rectal cancer

目的探讨部分横结肠皮下潜行(预造口)在腹腔镜低位直肠癌前切除术中的应用价值。方法将64例行低位直肠癌腹腔镜前切除术且符合保护性肠造口指征的直肠癌患者,按随机数字表法分为术中加行部分横结肠皮下潜行术(预造口组)34例,传统保护性横结肠造口术(传统造口组)30例。比较两组患者肠保护性肠造口率、永久性肠造口率,两次手术时间、术中出血量及间隔时间,并发症以及住院时间、治疗费用。结果两组患者均顺利完成一期手术,且无死亡。预造口组保护性肠造口率低于传统造口组(P<0.05);两组患者永久性肠造口率、两次手术时间及出血量、两期手术间隔时间比较,差异均无统计学意义(均P>0.05)。预造口组总并发症(包括一、二期手术围术期及术后随访期间)发生率、住院时间、住院费用均低于传统造口组(均P<0.05)。结论腹腔镜低位直肠癌前切除术中加行部分横结肠皮下潜行(预造口)是安全可行的。与加行传统保护性肠造口术式相比,能明显降低肠造口率,减少二次手术,降低相关并发症发生率。

Objective To evaluate the application of placing transverse colon underneath the skin(PTCUS)for preparing of colostomy in laparoscopic anterior resection of low rectal cancer.Methods Sixty-four patients with low rectal cancer were randomly assigned to receive PTCUS for preparing of colostomy(n=34)or traditional transverse colostomy(TTC,n=30).The rates of protective enterostomy and permanent enterostomy,postoperative complications,the medical expenses and the length of hospital stay were compared between the two groups.Results Patients in both groups successfully completed one-stage surgery,and there were no death.The rate of protective enterostomy in the PTCUS group was significantly lower than that in the TTC group(P<0.05).There was no significant difference between the two groups in the rate of permanent enterostomy,the time of operations,the volume of introperative bleeding and the interval between two procedures(P>0.05).The rates of perioperative and postoperative complications in the PTCUS group were lower than those in the TTC group(P<0.05).Conclusion It is safe and feasible to add PTCUS in laparoscopic resection of low rectal cancer operation.Compared with the TTC,it can significantly reduce the rate of colostomy,reduce the secondary operation,and significantly reduce the related complications.It is an alternative preventive measure for patients with high risk of anastomotic leakage.