直肠癌前切除术后预置回肠造口与袢式回肠造口的对比研究

Comparative study between ghost ileostomy and defunctioning ileostomy in anterior resection for rectal cancer

目的评估预置回肠造口(末段回肠预置于腹壁下)对比袢式回肠造口在腹腔镜直肠癌前切除术中的优势。方法进行前瞻性研究,纳入2020年1月至2021年12月甘肃省人民医院肛肠科收治的行腹腔镜直肠癌前切除术的患者,分为预置回肠造口组及袢式回肠造口组。主要的研究终点:首次住院以及术后3个月总体并发症指数(CCI);次要研究终点:术后吻合口漏发生率、肠梗阻发生率、手术时间、住院时间、住院费用、并发症Clavien-Dindo分级、术后3个月再次住院率以及肛门直肠功能(Wexner评分);其他研究终点:术后通气时间、首次进食时间、术后腹泻、手术时间>3 h、切缘阳性率以及术后病理pTNM分期。结果预置回肠造口组对比袢式回肠造口组的首次住院总体并发症评分(CCI评分)为(25.3±7.1 vs.26.4±5.7),差异无统计学意义(t=0.456,P=0.067),而预置回肠造口组对比袢式回肠造口组术后3个月的CCI评分为(26.2±6.2 vs.31.7±9.1),差异有统计学意义(t=0.283,P=0.041)。此外,预置回肠造口组患者对比袢式回肠造口组患者在手术时间(Z=-2.646,P=0.008)、住院时间(Z=-3.564,P=0.034)、住院费用(Z=-5.118,P=0.021)、术后3个月再次住院率(χ^(2)=25.652,P=0.001)、术后3个月肛门直肠功能(t=-3.128,P=0.003)以及并发症Clavien-Dindo分级(χ^(2)=9.692,P=0.021)等方面差异均具有统计学意义。结论预置回肠造口相对于袢式回肠造口是一种安全可行且经济有效的术式,但仅限于中低危吻合口漏患者。此外,本研究样本量较少且随访时间短,仍需后续试验加以验证。

Objective To evaluate the advantages of ghost ileostomy versus defunctioning ileostomy in laparoscopic anterior resection for rectal cancer.Methods Patients undergoing laparoscopic anterior resection of rectal cancer admitted to the Department of Proctology of Gansu Provincial People's Hospital from January 2020 to December 2021 were enrolled and divided into ghost ileostomy group and defunctioning ileostomy group.Primary end points:comprehensive complication index(CCI);secondary end points:incidence of postoperative anastomotic leakage,incidence of intestinal obstruction,operation time,length of hospital stay,hospitalization cost,Clavien-Dindo classification of complications,re-hospitalization rate at 3 months after surgery,and anorectal function(Wexner score).Other end points included postoperative ventilation time,first feeding time,postoperative diarrhea,operation time>3 h,positive rate of surgical margin,and postoperative pathological pTNM stage.Results There was no significant difference in the CCI score of the first hospitalization between the ghost ileostomy group and the defunctioning ileostomy group(25.3±7.1 vs.26.4±5.7)(t=0.456,P=0.067).However,the CCI score of the ghost ileostomy group was significantly different from that of the defunctioning ileostomy group at 3 months after operation(26.2±6.2 vs.31.7±9.1)(t=0.283,P=0.041).In addition,there were significant differences in operation time(Z=-2.646,P=0.008),length of hospital stay(Z=-3.564,P=0.034),hospitalization cost(Z=-5.118,P=0.021),re-hospitalization rate at 3 months after operation(χ^(2)=25.652,P=0.001),anorectal function at 3 months after operation(t=-3.128,P=0.003),and Clavien-Dindo classification of complications(χ^(2)=9.692,P=0.021)between the ghost ileostomy group and the defunctioning ileostomy group.Conclusion Ghost ileostomy is a safe,feasible and cost-effective procedure compared to defunctioning ileostomy,but it is limited to patients with a moderate to low risk of anastomotic leakage.In addition,the sample size of this study is small and the follow-up time is short,which still needs to be verified in subsequent trials.