腹腔镜辅助Miles术中腹膜外乙状结肠造口预防造口旁疝的价值

Extraperitoneal sigmoid colostomy in preventing parastomal hernia in laparoscopy-assisted Miles operation

目的比较腹腔镜辅助Miles术中采用腹膜外乙状结肠造口、腹膜内乙状结肠造口预防造口旁疝的效果及安全性。方法65例直肠癌患者均行腹腔镜辅助Miles术,术中采用腹膜外乙状结肠造口者28例为观察组,采用腹膜内乙状结肠造口者37例为对照组。比较2组性别、年龄、体质量指数、肿瘤下缘至肛缘距离;比较2组手术时间、术中出血量、术后住院时间及术后造口旁疝、造口脱垂、造口回缩、造口缺血、造口感染等并发症发生率。结果观察组年龄[(57.3±10.5)岁]、男性比率(53.6%)、体质量指数[(24.4±3.8)kg/m^(2)]、肿瘤下缘至肛缘距离[(3.1±1.4)cm]、手术时间[(301.4±59.9)min]、术中出血量[(192.9±102.4)mL]、术后住院时间[(15.1±6.5)d]与对照组[(62.4±9.9)岁、64.9%、(23.8±4.0)kg/m^(2)、(3.6±2.1)cm、(324.6±84.1)min、(196.5±124.6)mL、(13.8±5.8)d]比较差异均无统计学意义(P>0.05)。观察组造口旁疝发生率(7.1%)低于对照组(27.0%)(χ^(2)=4.186,P=0.041),造口脱垂(3.6%)、造口回缩(3.6%)、造口缺血(0)、造口感染(10.7%)发生率与对照组(8.1%、0、5.4%、13.5%)比较差异均无统计学意义(P>0.05)。结论腹腔镜辅助Miles术中采用腹膜外乙状结肠造口可降低造口旁疝发生率,具有较好的安全性。

Objective To compare the efficacy and safety of extraperitoneal sigmoid colostomy versus intraperitoneal sigmoid colostomy in preventing parastomal hernia in laparoscopy-assisted Miles operation.Methods Sixty-five patients with rectal cancer underwent laparoscopy-assisted Miles operation,in which 28 patients were performed extraperitoneal sigmoid colostomy(observation group),and 37 patients were performed intraperitoneal sigmoid colostomy(control group).The clinical data as gender,age,body mass index,distance from tumor lower edge to anal edge,operation lasting time,intraoperative blood loss,length of postoperative hospital stay,and incidences of postoperative complications as parastomal hernia,stoma prolapse,stoma retraction,stoma ischemia and stoma infection were compared between two groups.Results There were no significant differences in the patient’s age[(57.3±10.5)years vs.(62.4±9.9)years],male ratio(53.6%vs.64.9%),body mass index[(24.4±3.8)kg/m^(2)vs.(23.8±4.0)kg/m^(2)],distance from tumor lower edge to anal edge[(3.1±1.4)cm vs.(3.6±2.1)cm],operation lasting time[(301.4±59.9)min vs.(324.6±84.1)min],intraoperative blood loss[(192.9±102.4)mL vs.(196.5±124.6)mL],and length of postoperative hospital stay[(15.1±6.5)d vs.(13.8±5.8)d]between observation group and control group(P>0.05).The incidence of parastomal hernia was lower in observation group(7.1%)than that in control group(27.0%)(χ^(2)=4.186,P=0.041),and there were no significant differences in the incidences of stoma prolapse(3.6%vs.8.1%),stoma retraction(3.6%vs.0),stoma ischemia(0 vs.5.4%),and stoma infection(10.7%vs.13.5%)between observation group and control group(P>0.05).Conclusion Extraperitoneal sigmoid colostomy in laparoscopy-assisted Miles operation can reduce the incidence of parastomal hernia and it is quite safe.