留置肛管与预防性回肠造口在腹腔镜低位直肠癌根治保肛手术中的应用

Application of indwelling anal canal and preventive ileostomy in laparoscopic radical resection of low rectal cancer with preservation of anus

目的探讨留置肛管在腹腔镜低位直肠癌根治保肛手术中的应用及疗效。方法选取2019年1月至2021年9月在安徽医科大学附属安庆第一人民医院就诊的72例低位直肠癌患者的临床资料行回顾性分析,依据不同治疗方式分为观察组(腹腔镜低位直肠癌根治保肛+留置肛管手术)29例,对照组(腹腔镜低位直肠癌根治保肛+预防性回肠造口手术)43例,并比较两组围手术期指标、术后并发症等。结果本组72例患者均顺利完成手术,无死亡病例。观察组手术时间[(173.45±10.62)min]、术后肛门首次排气时间[(44.24±6.34)h]、住院时间[(9.93±1.89)d]及焦虑自评量表(SAS)得分[(42.93±5.78)分]均少于对照组[(184.65±10.77)min、(76.93±7.35)h、(10.98±2.06)d、(54.40±6.36)分],差异有统计学意义(P<0.05)。而两组术中出血量、术后并发症发生率差异无统计学意义(P>0.05)。结论留置肛管在腹腔镜低位直肠癌根治保肛手术中与预防性回肠造口相比,并未增加吻合口漏的发生率,同样安全有效,且更有益于患者术后的康复。

Objective To investigate the effect of indwelling anal canal in laparoscopic radical resection of low rectal cancer with preservation of anus.Methods Seventy-two patients with low rectal cancer in Anqing First People's Hospital of Anhui Medical University from January 2019 to September 2021 were selected for retrospective analysis.According to different treatment methods,they were divided into the observation group(laparoscopic radical resection of low rectal cancer with preservation of anus surgery+indwelling anal canal,n=29)and the control group(laparoscopic radical resection of low rectal cancer with preservation of anus surgery+preventive ileostomy,n=43),and then the perioperative indexes and postoperative complications were compared.Results All 72 patients were completed the operation successfully without death.The operation time[(173.45±10.62)min vs(184.65±10.77)min],the first exhaust time after operation[(44.24±6.34)h vs(76.93±7.35)h],hospitalization time[(9.93±1.89)d vs(10.98±2.06)d]and SAS score[(42.93±5.78)points vs(54.40±6.36)points]in the observation group were lower than those in the control group,the difference were statistically significant(P<0.05).There was no significant difference in intraoperative bleeding volume and the incidence of postoperative complications between the two groups(P>0.05).Conclusions Compared with preventive ileostomy,indwelling anal canal does not increase the incidence of anastomotic leakage in laparoscopic radical resection of low rectal cancer with preservation of anus,which is also safe and effective,and more conducive to the recovery of patients after operation.