直肠癌切除术后乙状结肠腹膜外造口并发症和功能对照分析

目的探讨剖腹及腹腔镜下直肠癌术后乙状结肠腹膜外造口的并发症和造口功能。方法分析2014年1月至2017年12月行剖腹或腹腔镜下直肠癌根治术及乙状结肠腹膜外造口的患者的临床及随访资料,比较两组患者的造口并发症发生率;采用克利夫兰医学中心佛罗里达造口功能指数(CCFOFI)评分表进行造口功能评估,比较两组间造口功能的差异。结果随访截至2019年6月,中位随访时间为37个月。纳入共155例患者,其中剖腹组94例,腹腔镜组61例。腹腔镜组的造口旁疝发生率高于剖腹组(P=0.047),腹腔镜组的皮肤刺激发生率高于剖腹组(P=0.014),其他并发症发生率两组间差异无统计学意义(P>0.05)o腹腔镜组的CCFOFI总分低于剖腹组,差异存在统计学意义(P=0.000),提示腹腔镜组的造口功能优于剖腹组。CCFOFI的七个条目中,更换造口袋频率、更换造口袋难度、需协助更换造口袋等条目的差异有统计学意义(P=0.000,0.000、0.003),腹腔镜组优于剖腹组,其余条目的差异无统计学意义(P>0.05)。结论由于手术操作的差异,腹腔镜下乙状结肠腹膜外造口比剖腹手术容易发生造口旁疝及造口周围皮肤刺激。用CCFOFI进行造口功能评价,腹腔镜下乙状结肠腹膜外造口的功能优于剖腹手术,但可能与两组患者的年龄差异相关,需进一步的随机临床试验来验证。

Objective To investigate the complications and stoma function of open and laparoscopic extraperitoneal sigmoid colostomy.Methods The clinical and follow-up data of patients underwent open or laparoscopic radical resection of rectal cancer and sigmoid extraperitoneal stoma from January 2014 to December 2017 were analyzed.The incidence of stoma complications were compared between the two groups.The ostomy function was compared,which was evaluated using the Cleveland Clinic Florida Ostomy Function Index(CCFOFI)score.Results The median follow-up was 37 months as of June 2019.A total of 155 patients were included in the data,including 94 patients in open group and 61 patients in laparoscopy group.The incidence of Parastomal Hemia in laparoscopic group was higher than that in open group(P=0.047).The incidence of skin irritation in laparoscopic group was higher than that in open group(P=0.014).There was no significant difference in other compbcations between the two groups(P>0.05).The total score of CCFOFI in laparoscopy group was lower than that in open group(P=0000).Among the seven items of CCFOFI,there were significant difierences between the two groups in terms of frequency of change,difficulty with change and need assistance of change(P=0.000,0.000,0.003),laparoscopic group was superior to open group,there was no significant difierence of the other items(P>0.05).Conclusion Because of the difference of operation,laparoscopic extraperitoneal sigmoid colostomy is more likely to cause parastomal hemia and skin irritation around the stoma than open operation.The ostomy function of laparoscopic group was better than that of open group by CCFOFI,but it may be related to the age diHerence between the two groups and need further randomized clinical trial.