改良末端回肠悬吊在腹腔镜下低位直肠癌根治术中的应用

Clinical application of improved terminal ileum suspension in laparoscopic radical resection for lowrectal cancer

目的探讨改良末端回肠悬吊在腹腔镜下低位直肠癌根治术中的临床应用价值。方法选取2017年7月至2019年7月收治住院的低位直肠癌患者,随机分为A、B、C三组,各30例:A组行腹腔镜下直肠癌根治术(Dixon);B组行Dixon加预防性末端回肠造口术;C组行Dixon加改良末端回肠悬吊术。比较三组术前1天及术后第1、3、7天营养学指标,外周血电解质浓度,住院总费用,术后首次下床活动时间、肛门首次排气时间、住院时间以及并发症发生率。结果患者接受不同手术方式对营养物质及电解质的吸收利用未产生显著改变。B组肛门首次排气时间明显缩短(F=0.004,P<0.05),二次手术率(100.00%)与A、C组的3.33%(1/30)相比显著升高(χ2=81.562,P<0.001)。A组术后发生切口感染、吻合口瘘各1例(6.67%),B组发生造口相关并发症2例(6.67%),C组发生吻合口瘘1例(3.33%),三组患者术后并发症发生率比较,差异无统计学意义(χ2=0.424,P=0.809)。结论改良末端回肠悬吊术操作简单,不影响患者术后恢复,能有效降低造口还纳手术率,减轻患者因造口带来的心理压力和二次手术的经济负担。

Objective To discuss the clinical application of improved terminal ileum suspension in laparoscopic radical resection for low-rectal cancer.Methods From July 2017 to July 2019,ninety pantients with low rectal cancer who underwent laparoscopic operation in the First People’s Hospital were randomly divided into three groups:Group A(30 cases)received laparoscopic radical resection of recral cancer(Dixon);Group B(30 cases)received Dixon and preventive ileostomy;Group C(30 cases)received Dixon and improved terminal ileum suspension.Peripheral blood nutritional indicators and the levels of electrolytes of three groups were observed 1 d before operation and 1,3 and 7 d after operation.The three groups were compared in terms of first getting out-of-bed time,first exhaust time,postoperative hospital stay,total cost for hospitalization and postoperative complications.Results The absorption and utilization of nutrients and electrolytes were not significantly changed by different operation methods.First exhaust time was earlier in the group B(F=0.004,P<0.05).Compared with 3.33%(1/30)of group A and group C,the re-operation rate increased obviously(100.00%)(χ2=81.562,P<0.001).There were 1 case of incision infection and 1 case of anastomotic leakage(6.67%)in group A,2 cases of stoma related complications(6.67%)in group B and 1 case of anastomotic leakage(3.33%)in group C.No statistical differences were shown in first getting out-of-bed time,postoperative hospital stay,total cost for hospitalization,postoperative complications among the three groups.Conclusion Improved terminal ileum suspension is simple to operate,and does not affect the postoperative recovery of patients,effectively reducing the rate of small intestinal stoma closure operation,relieving the psychological pressure caused by stoma and the economic stress of secondary surgery.