腹腔镜腹膜外隧道式结肠造口的临床疗效

Clinical Efficacy of Laparoscopic Extraperitoneal Tunnel-type Sigmoidostomy

目的探讨腹腔镜腹膜外隧道式结肠造口在低位直肠癌术后的临床疗效。方法2015年1月~2019年12月我院60例因低位直肠癌行腹腔镜腹会阴联合切除术需行结肠造口,其中腹膜外隧道式结肠造口30例(腹膜外造口组),经腹膜结肠造口30例(腹膜造口组),比较2种造口方法造口时间、住院时间、术后排便预感和造口旁疝、回缩等。结果腹膜外造口组与腹膜造口组在造口时间、住院时间、排气时间差异无显著性[(35.4±9.7)min vs.(32.5±8.8)min,t=1.210,P=0.231;(55.6±12.1)h vs.(58.7±13.5)h,t=0.924,P=0.359;(9.4±3.6)d vs.(8.9±3.2)d,t=0.569,P=0.572]。60例术后随访9~57个月,中位随访时间26.4月,腹膜外造口组造口旁疝发生率明显低于腹膜造口组[6.6%(2/30)vs.26.7%(8/30),χ2=4.320,P=0.038]。腹膜外造口组14例(46.7%)排便前有明显预感,明显多于腹膜造口组6例(20.0%)(χ2=4.800,P=0.028)。结论腹腔镜腹膜外隧道式结肠造口术简单实用,不延长造口时间及住院时间,可减少造口旁疝并发症发生率,提高患者造口排便前的预感,有利于造口护理,值得临床推广。

Objective To discuss the clinical efficacy of laparoscopic extraperitoneal tunnel-type sigmoidostomy for low rectal cancer.Methods A total of 60 cases who underwent laparoscopic abdominoperineal sigmoidostomy for low rectal cancer in our hospital from January 2015 to December 2019 were selected and divided into the extraperitoneal sigmoidostomy group or intraperitoneal sigmoidostomy group,with 30 cases in each group.The oncolostomy time,hospital stay,postoperative sense of defecation and complications such as parastomal hernia and stoma retraction were compared between the two groups.Results There were no statistically significant differences between the extraperitoneal sigmoidostomy group and the intraperitoneal sigmoidostomy group in the colostomy time,hospital stay and exhaust time,respectively[(35.4±9.7)min vs.(32.5±8.8)min,t=1.210,P=0.231;(55.6±12.1)h vs.(58.7±13.5)h,t=0.924,P=0.359;(9.4±3.6)d vs.(8.9±3.2)d,t=0.569,P=0.572].All the patients were followed up for 9-57 months(median,26.4 months).The incidence of parastomal hernia was significantly lower in the extraperitoneal sigmoidostomy group than that in the intraperitoneal sigmoidostomy group[6.6%(2/30)vs.26.7%(8/30),χ2=4.320,P=0.038].There were 14 patients in the extraperitoneal sigmoidostomy group who had clear sense of defecation,and only 6 in the intraperitoneal sigmoidostomy group(χ2=4.800,P=0.028).Conclusions The laparoscopic extraperitoneal tunnel-type sigmoidostomy is simple and practicable,by which the operative time and the hospital stay are not prolonged,the incidence of the complications such as parastomal hernia can be reduced,and the sense of defecation of patients can be improved after the operation.It is worthy of clinical promotion.