低位直肠癌手术行预防性造口100例分析

Analysis of defunctioning stoma in 100 patients with low rectal cancer surgery

目的探究与分析低位直肠癌手术行预防性造口的应用价值。方法回顾性分析我院自2014年3月~2019年3月收治的100例低位直肠癌患者的临床资料,将接受预防性造口的54例患者作为观察组,另将未接受预防性造口的46例患者作为对照组,比较两组患者围术期指标、术后并发症发生率及死亡率。结果两组患者的性别、年龄、病理类型、肿瘤分期、体重指数、术后是否进行新辅助化疗、肿瘤距肛缘距离比较,差异无统计学意义(P>0.05)。观察组首次肛门排气时间、首次进食时间及住院时间均短于对照组,差异有统计学意义(P<0.05)。观察组吻合口瘘发生率低于对照组,差异有统计学意义(P<0.05);两组肠梗阻率、切口感染率、死亡率比较,差异无统计学意义(P>0.05)。对照组出现的8例吻合口瘘中有6例存在严重的腹痛症状,并表现出持续性高热,在引流管中可见粪液,另有2例患者合并腹腔感染,直至器官功能衰竭死亡。观察组1例吻合口瘘于术后7d内出现,症状较为严重,且死亡。结论低位直肠癌手术行预防性造口可明显降低术后吻合口瘘的发生率,缩短首次肛门排气时间、进食时间及住院时间。

Objective To explore and analyze the application value of defunctioning stoma in low rectal cancer surgery.Methods The clinical data of 100 patients with low rectal cancer admitted to our hospital from March 2014 to March 2019 were retrospectively analyzed.54 patients who received a preventive stoma were used as the observation group,and 46 patients who did not receive a preventive stoma were used as the control group.The perioperative indicators,postoperative complication rate and mortality were compared between the two groups.Results There were no statistically significant differences between the two groups in gender,age,pathological type,tumor stage,body mass index,postoperative neoadjuvant chemotherapy,or distance from the tumor to anal verge(P>0.05).Compared with the control group,the time to first anal exhaust and first feeding and hospitalization time in the observation group were lower,the differences were statistically significant(P<0.05).Compared with the control group,the incidence of anastomotic leakage in the observation group was lower,the difference was statistically significant(P<0.05).There were no statistically significant differences in intestinal obstruction,incision infection rate and mortality between the two groups(P>0.05).Of the 8 cases of anastomotic leakage in the control group,6 cases had severe abdominal pain and showed persistent high fever,and fecal fluid was visible in the drainage tube;the other 2 cases had abdominal infections until organ failure and death.In the observation group,1 case of anastomotic leakage occurred within 7 days after the operation with severe symptoms and died.Conclusion Defunctioning stoma for low rectal cancer surgery can significantly reduce the incidence of anastomotic leakage after surgery,and shorten the time to first anal exhaust and first feeding and hospitalization time.