快速康复外科在低位直肠癌术后保护性回肠造口早期还纳中的临床价值

Clinical value of fast track surgery in the early return of protective ileostomy after low-lying rectal cancer surgery

目的探讨低位直肠癌早期还纳末端回肠造口的可行性及安全性,为快速康复外科(FTS)造口还纳的最佳时机提供循证医学证据。方法收集2016年1月至2019年12月武汉市第四医院诊治65例进行保护性回肠造口还纳术患者进行研究,将患者分为早期还纳阻(快速康复外科理念干预,30例)和常规还纳组(常规干预,35例),比较两组患者手术时间、术后吻合口漏、肠梗阻、切口感染、造口相关并发症等指标。结果结果表明早期还纳组手术时间少于常规还纳组[(37.53±10.23)min比(60.23±16.56)min,t=-6.513,P<0.05];造口护理费用、造口相关并发症发生率、造口还纳难易程度低于常规还纳组[(510.67±37.32)元比(2361.43±126.08)元,t=-82.722,P<0.05;6.67%(2/30)比31.43%(11/35),χ^(2)=6.190,P<0.05;(25/30)比(17/35),χ^(2)=8.538,P<0.05],切口关闭难易程度低于常规还纳组(χ^(2)=4.127,P<0.050),但切口感染发生率高于常规还纳组[26.67%(8/30)比5.71%(2/35),χ^(2)=3.957,P<0.05],差异均有统计学意义;术后肠梗阻发生率[7.00%(2/30)比17.00%(6/35),χ^(2)=0.815,P>0.05]、术后吻合口漏发生率[0%(0/30)比3%(1/35),P>0.05(Fisher确切概率法)]基本相似,差异均无统计学意义。结论早期还纳末端回肠造口安全可行,并不增加手术并发症,且能够减少造口相关并发症,提高患者的生活质量。

Objective To explore the feasibility and safety of early reconciliation of terminal ileostomy for low-lying rectal cancer,and to provide evidence-based medical evidence for the optimal timing of colostomy in fast track surgery.Methods From January,2016 to December,2019,65 patients with protective ileostomy in our hospital were studied.The patients were divided into early closure group(30 cases)and routine group(35 cases).The operation time,postoperative anastomotic leakage,intestinal obstruction,incision infection and stoma related complications were compared between the two groups.Results The operation time,stoma nursing cost,incidence of stoma-related complications,difficulty of stoma-returning were lower in the early closure group than in the conventional group(t=-6.513,P<0.05;t=-82.722,P<0.05;χ^(2)=6.190,P<0.05;χ^(2)=8.538,P<0.05).The difficulty of incision closure was lower than that in the late closure group(χ^(2)=4.127,P<0.050),but the incidence of incision infection was higher than that in the late closure group[26.67%(8/30)vs.5.71%(2/35),χ^(2)=3.957,P<0.05]The incidence of postoperative intestinal obstruction(χ^(2)=0.815,P>0.05)and postoperative anastomotic leakage(P>0.05)were basically similar.Conclusion Early closure of terminal ileostomy is safe and feasible,without increasing surgical complications,and can reduce stoma-related complications and improve patients′quality of life.