腹腔镜低位直肠癌根治性保肛手术中预防性造口的效果观察

Effect of preventive colostomy in laparoscopic radical sphincter preserving surgery for low rectal cancer

目的:探讨腹腔镜低位直肠癌(ISR)根治性保肛手术中预防性造口的效果。方法:抽取2017年9月至2019年10月在郑州人民医院行腹腔镜ISR根治性保肛手术患者106例,根据随机数字表法分为两组,每组53例。观察组予以回肠末端预防性双腔造口,对照组不予以预防性造口。记录两组患者围术期手术指标、术后情况、肛门功能情况及术后并发症发生情况、术后6个月复发情况。结果:两组术中出血量比较,差异未见统计学意义(P>0.05);观察组手术时间长于对照组(P<0.05);观察组首次排气、首次下床、平均住院时间、补液总天数均短于对照组(P<0.05);观察组术后14 d、6个月肛门功能评分均高于对照组(P<0.05);观察组总并发症发生率(5.66%)低于对照组(18.87%),P<0.05;两组术后6个月均未出现复发。结论:对行腹腔镜ISR根治性保肛手术患者实施预防性造口,能有效改善患者肛门功能,缩短术后恢复时间,且并发症发生率较低,安全性高。

Objective To investigate the effect of preventive colostomy in laparoscopic radical anus preservation operation for low rectal cancer(ISR).Methods A total of 106 cases of patients with laparoscopic ISR radical anus preservation operation in Zhengzhou People’s Hospital from September 2017 to October 2019 were selected,and they were divided into two groups by random number,53 cases in each group.Observation group was given terminal ileum preventive double-cavity colostomy,while control group was not given preventive colostomy.The perioperative indexes,postoperative situation,anal function,postoperative complications,postoperative six-month recurrence of two groups were recorded.Results There was no significant difference in blood loss between the two groups(P>0.05);the operation time of observation group was higher than that of control group(P<0.05);the first exhaust,first leaving bed,total days of fluid infusion,mean hospital stays in observation group were shorter than those in control group(P<0.05);the operation scores of anal function in observation group were higher than those in control group 14 days and 6 months after operation(P<0.05);the incidence of total complications in observation group(5.66%)was significantly lower than that in control group(18.87%),P<0.05;there was no recurrence 6 months after operation in the two groups.Conclusions Preventive colostomy in patients with laparoscopic ISR radical anus preservation operation can effectively improve anal function,shorten postoperative recovery time,and have lower incidence of complications and higher safety.