回肠预防性造口:是福还是祸?

Prophylactic ileostomy: a boon or a scourge ?

目前,直肠低位前切除术已经成为直肠癌应用最为广泛的术式。吻合口瘘是直肠癌术后最常见的并发症之一,而预防性造口曾被认为可以降低其发生风险,临床上有滥用之势。越来越多的证据表明回肠预防性造口弊大于利,它会增加患者的身心及经济负担。本文就预防性造口的“理论依据”以及回肠预防性造口利与弊进行阐述,同时从卫生经济学、国家医保政策及人文关怀层面提出了一些思考与建议。

Rectal low anterior resection has become the most widely used surgical procedure of rectal cancer.Anastomotic leakage is one of the most common complications after rectal surgery.Prophylactic ileostomy was once thought to reduce the risk of anastomotic leakage,but it has been abused clinically.However,more and more evidence has showed that ileostomy does more harm than good.It will increase physical,psychological and economic burden of patients.This paper describes the“theoretical foundation”and advantages and disadvantages of prophylactic ileostomy.At the same time,some considerations and suggestions are put forward from the aspects of health economics,national medical insurance policy and humanistic care.