改良一针法预防性回肠造口术在直肠癌腹腔镜低位前切除术患者中的应用效果

Modified one-stitch method of prophylactic ileostomy in laparoscopic low anterior resection for patients with rectal cancer

目的探讨改良一针法预防性回肠造口术在直肠癌腹腔镜低位前切除术患者中的应用效果。方法选取2018年1月至2021年6月我科收治的60例行腹腔镜低位前切除+预防性回肠造口术的直肠癌患者作为研究对象。根据预防性回肠造口术实施方式的不同,分为改良一针法预防性回肠造口术组(改良组,n=32)与传统预防性回肠造口术组(传统组,n=28)。比较两组手术时间,包括根治术共需手术时间(低位前切除+预防性回肠造口术)、造口还纳术手术时间,以及并发症发生情况(包括吻合口漏及造口相关并发症)。结果两组手术过程顺利,在预防性回肠造口术后3~4个月完成造口还纳术。改良组根治术共需手术时间、造口还纳术手术时间均短于传统组,差异有统计学意义(均P<0.05)。两组均未出现吻合口漏及造口狭窄、造口肠坏死病例。两组造口皮肤黏膜分离、粪水性皮炎、造口回缩、造口旁疝、造口脱垂、造口感染发生率比较差异均无统计学意义(均P>0.05)。改良组造口相关并发症总发生率低于传统组,差异有统计学意义(P<0.05)。结论相比传统预防性回肠造口术,改良一针法预防性回肠造口术操作更为简单,有助于减少造口相关并发症的发生,也可缩短造口还纳术所需要的手术时间。

Objectives To investigate the effectiveness of the modified one-stitch method of prophylactic ileostomy in laparoscopic low anterior resection for patients with rectal cancer.Methods Sixty patients treated at our department between January2018 and June 2021 with laparoscopic low anterior resection and prophylactic ileostomy were included.Depending on the method of prophylactic ileostomy,patients were divided into the modified one-stitch group(receiving the modified one-stitch method,n=32)and the traditional group(receiving the traditional method,n=28).The duration of surgery(including duration of low anterior resection and prophylactic ileostomy and duration of stoma reversal)and the occurrence of complications(including anastomotic leakage and stoma-related complications)were compared between the two groups.Results Surgeries were uneventful in both groups.The stoma reversal was performed 3 to 4 months after the prophylactic ileostomy.Duration of low anterior resection and prophylactic ileostomy,and duration of stoma reversal was significantly shorter in the modified one-stitch group than in the traditional group(P<0.05).No patients had anastomotic leakage,stomal stricture,and intestinal necrosis.The incidence of the separation of stoma skin and mucosa,fecal dermatitis,stoma retraction,parastomal hernia,stoma prolapse,and stoma infection was similar between the two groups(P>0.05).The total incidence of stoma-related complications was significantly lower in the modified group than in the traditional group(P<0.05).Conclusion Compared with the traditional prophylactic ileostomy,the modified onestitch method of prophylactic ileostomy is a more straightforward procedure that can reduce the occurrence of stoma-related complications and the duration of stoma reversal.