微创根治术中预防性回肠末端造口对直肠癌患者临床疗效及肛门功能的影响

Effect of preventive ileostomy in minimally invasive radical operation on clinical efficacy and anal function in patients with rectal cancer

目的探讨微创根治术中预防性回肠末端造口对直肠癌患者临床疗效及肛门功能的影响。方法选取2017年9月至2020年5月于安徽省池州市人民医院进行诊断并治疗的91例直肠癌患者为研究对象,根据手术方式将其分为观察组和对照组。观察组(32例)行腹腔镜根治术加回肠末端造口,对照组(59例)行单纯行腹腔镜根治术。比较两组围手术期指标、胃肠功能改变情况、手术后恢复情况、实验室指标、肛门功能评分及并发症发生情况。结果两组肠鸣音恢复时间、排气时间、开始进食时间、手术时间、术中出血量、切除病灶长度及淋巴结清扫总量比较,差异无统计学意义(P>0.05)。观察组首次下床时间、术后补液天数及住院时间均短于对照组,差异有统计学意义(P<0.05)。两组术后2 d及5 d的白细胞、C反应蛋白均高于术前,前白蛋白水平低于术前,术后5 d的白细胞、C反应蛋白水平均低于术后2 d,前白蛋白水平高于术后2 d,差异均有统计学意义(均P<0.05)。观察组术后2 d的白细胞水平高于同一时间点的对照组,C反应蛋白、前白蛋白水平均低于同一时间点的对照组;术后5 d的白细胞、C反应蛋白水平均低于同一时间点的对照组,前白蛋白水平高于同一时间点的对照组,差异均有统计学意义(均P<0.05)。两组术后14 d、3个月、6个月的肛门功能评分均高于术前,术后3个月及6个月均高于术后14 d,术后6个月高于术后3个月,差异均有统计学意义(均P<0.05)。观察组术后14 d及术后6个月的肛门功能评分均高于同一时间点的对照组,术后3个月低于同一时间点的对照组,差异均有统计学意义(均P<0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论直肠癌患者在微创根治术中预防性回肠末端造口有利于提升患者的肛门功能,促进生命质量的提高。

Objective To investigate the effect of preventive ileostomy in minimally invasive radical operation on clinical efficacy and anal function in patients with rectal cancer.Methods A total of 91 patients with rectal cancer who were diagnosed and treated in the People’s Hospital of Chizhou,Anhui Province from September 2017 to May 2020 were selected as the research subjects,and they were divided into observation group and control group according to the operative methods.The observation group(32 cases)received laparoscopic radical resection combined with ileostomy,while the control group(59 cases)received laparoscopic radical resection alone.Perioperative indexes,changes in gastrointestinal function,postoperative recovery,laboratory indexes,anal function score and complications were compared between the two groups.Results There were no significant differences in intestinal sound recovery time,exhaust time,starting feeding time,operation time,intraoperative blood loss,length of resected lesions and total amount of lymph node dissection between the two groups(P>0.05).The time of getting out of bed for the first time,the number of days of fluid rehydration after operation and the length of hospital stay in the observation group were shorter than those in the control group,with statistical significance(P<0.05).The levels of white blood cells and C-reactive protein 2 and 5 d after operation were higher than those before operation,and the levels of pre-albumin were lower than those before operation.The levels of white blood cells and C-reactive protein 5 d after operation were lower than those 2 d after operation,and the levels of pre-albumin were higher than those 2 d after operation,with statistical significance(P<0.05).The levels of white blood cells in observation group were higher than those in control group at the same time point,and the levels of C-reactive protein and pre-albumin in observation group were lower than those in control group at the same time point.The levels of white blood cells and C-reactive protein at 5 d after operation were lower than those in the control group at the same time point,and the levels of pre-albumin were higher than those in the control group at the same time point,with statistical significance(all P<0.05).The scores of anal function at 14 d,3 and 6 months after operation in both groups were higher than those before operation;those at 3 and 6 months after operation were higher than those at 14 d,and those at 6 months after operation were higher than those at three months after operation,with statistical significance(all P<0.05).The scores of anal function in the observation group at 14 d and 6 months after operation were higher than those in the control group at the same time point,and the scores at 3 months after operation were lower than those in the control group at the same time point,with statistical significance(P<0.05).There was no significant difference in the total incidence of complication between the two groups(P>0.05).Conclusion In patients with rectal cancer,the preventive of ileostomy during minimally invasive radical operation is beneficial to improve the anal function of patients and promote the improvement of life quality.