经腹膜外途径永久性乙状结肠造口在腹腔镜下腹会阴直肠切除术中的应用

Application of Extraperitoneal Approach Permanent Sigmoid Colostomy in Laparoscopic Abdominal Perineorectom

目的:探讨在腹腔镜腹会阴直肠切除术(APR)中经腹膜外途径永久性乙状结肠造口与造口相关并发症,尤其是造口旁疝(PSH)之间的关系。方法:回顾性分析2013年1月-2019年12月福建医科大学附属漳州市医院收治的67例接受同一主刀医生操作的腹腔镜下APR手术患者的临床资料,按从腹膜外和经腹膜造口途径的不同分为经腹膜外(EP)组34例和经腹膜(TP)组33例。比较两组围手术期指标及与造口相关的并发症发生情况。结果:两组总手术时间、术中出血量和术后住院时间比较,差异均无统计学意义(P>0.05)。EP组1例(2.94%)和TP组8例(24.24%)患者出现了PSH,两组PSH发生率比较,差异有统计学意义(P<0.05)。两组造口脱垂、造口回缩、造口黏膜皮肤分离、造口周围皮炎、切口、盆腔感染和术后肠梗阻发生率比较,差异均无统计学意义(P>0.05)。结论:经腹膜外途径造口显著降低腹腔镜下APR手术后PSH的发生率,推荐腹腔镜下APR手术采用腹膜外途径永久性乙状结肠造口术。

Objective:To investigate the relationship between permanent sigmoid colostomy via extraperitoneal approach and stoma-related complications,especially parastomal hernia(PSH)in laparoscopic abdominal perineorectomy(APR).Method:The clinical data of 67 patients underwent laparoscopic APR operated by the same primary surgeon in Zhangzhou Affiliated Hospital of Fujian Medical University from January 2013 to December 2019 were retrospectively analyzed,they were divided into 34 cases in the extraperitoneal(EP)group and 33 cases in the transperitoneal(TP)group according to the difference between extraperitoneal and transperitoneal stoma approachs.The perioperative indicators and complications associated with the stoma were compared between the two groups.Result:There were no significant differences in total operation time,intraoperative blood loss and postoperative hospital stay between the two groups(P>0.05).PSH was found in 1 patient(2.94%)of EP group and 8 patients(24.24%)of TP group.There was significant difference in the incidence of PSH between the two groups(P<0.05).There were no significant differences in the incidences of ostomy prolapse,ostomy retraction,ostomy mucosal skin separation,periostomy dermatitis,incision,pelvic infection and postoperative intestinal obstruction between the two groups(P>0.05).Conclusion:The incidence of PSH after laparoscopic APR surgery is significantly reduced by stoma via the extraperitoneal approach,and permanent sigmoidostomy by the extraperitoneal approach is recommended for laparoscopic APR surgery.