末端回肠造口术和横结肠造口术对低位直肠癌腹腔镜保肛手术患者围术期指标术后并发症和预后的影响

Influence of Terminal Ileostomy and Transverse Colostomy on Perioperative Indicators Postoperative Complications and Prognosis of Patients with Low Rectal Cancer Undergoing Laparoscopic Anus-preserving Surgery

目的:对比末端回肠造口术和横结肠造口术对低位直肠癌腹腔镜保肛手术患者围术期指标、术后并发症和预后的影响。方法:回顾性分析2018年1月至2020年4月本院收治151例低位直肠癌行腹腔镜保肛手术患者的临床资料,按照不同造口方式分为观察组(n=78,末端回肠造口术)、对照组(n=73,横结肠造口术)。比较两组围术期指标、术后1、6、12个月时的肛门情况(Wexner肛门功能评分量表)、术后6个月排便情况(徐忠法五项十分制评分)、术后1、6、12个月时的预后情况[癌症患者生命质量测定量表(EOETC QLQ-C30)],比较两组并发症发生情况。结果:两组手术时间、术中出血量比较无统计学意义(P>0.05),观察组术后首次进食时间、术后首次排便时间、住院时间明显低于对照组(P<0.05)。肛门情况评分组间、时间点差异及分组与时点交互作用均有统计学意义(P<0.05)。术后6个月,观察组排便情况优良率明显高于对照组(P<0.05)。EOETC QLQ-C30评分组间、时间点差异均有统计学意义(P<0.05),分组与时点的交互作用不具有统计学意义(P>0.05)。两组并发症发生率比较无统计学意义(P>0.05)。结论:与横结肠造口术相比,末端回肠造口术在低位直肠癌腹腔镜保肛手术患者中能够促进术后恢复及肛门恢复,改善患者预后。

Objective:To compare the influence of terminal ileostomy and transverse colostomy on perioperative indicators,postoperative complications and prognosis of patients with low rectal cancer undergoing laparoscopic anus-preserving surgery.Methods:The clinical data of 151 patients with low rectal cancer who received laparoscopic anus-preserving surgery in the hospital between January 2018 and April 2020were retrospectively analyzed.According to different stoma methods,they were divided into observation group(n=78,terminal ileostomy)and control group(n=73,transverse colostomy).The perioperative indicators,anal status at 1 month,6 months and 12 months after surgery(Wexner anal function score scale),defecation status at 6 months after surgery(Xu Zhongfa's five-item ten-point scale)and prognosis at 1 month,6 months and 12 months after surgery[European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30(EOETC QLQ-C30)]were compared.The complications of the two groups were compared.Results:There was no statistical significance in the surgical time and intraoperative blood loss between the two groups(P>0.05).The postoperative first eating time,first defecation time and hospital stay were obviously shorter in observation group than in control group(P<0.05).There were statistical distinctions in the between-group effect,time-point effect and interaction effect of between-group and time-point of anal status score(P>0.05).The excellent and good rate of defecation status in observation group was observably higher than that in control group at 6 months after surgery(P<0.05).There were statistically significant differences in the between-group effect and time-point effect of EOETC QLQ-C30 evaluation(P<0.05),but the interaction effect of between-group and time-point was not statistically significant(P>0.05).There were no obvious differences in the incidence rates of complications between groups(P>0.05).Conclusion:Compared with transverse colostomy,terminal ileostomy has a better application effect on patients with low rectal cancer undergoing laparoscopic anus-preserving surgery.It can promote postoperative recovery and anal recovery,and improve the prognosis of patients.