预防性末端回肠造瘘术在老年人左半结肠癌并发急性肠梗阻Ⅰ期切除中的应用

Application of prophylactic end ileostomy in stage Ⅰ resection of left colon cancer complicated with acute intestinal obstruction in the elderly

目的探讨预防性末端回肠造瘘术在老年人左半结肠癌并发急性肠梗阻Ⅰ期切除吻合术中的应用价值。方法回顾性分析老年左半结肠癌并发急性肠梗阻Ⅰ期切除吻合术53例患者的临床资料,其中行预防性末端回肠造瘘术患者25例作为A组,未行预防性末端回肠造瘘术患者28例作为B组,比较两组手术时间、术中出血量、术后首次排气时间、进食时间、住院时间、吻合口瘘发生情况。结果 A组术后首次排气时间、进食时间、住院时间分别为(2.5±0.7)、(3.0±0.8)、(9.0±2.0)d,均显著短于B组的(4.0±0.7)、(7.0±1.4)、(13.0±2.0)d,差异有统计学意义(P<0.05);A组吻合口瘘发生率为4.0%,显著低于B组的28.6%,差异有统计学意义(P<0.05)。两组手术时间、术中出血量比较差异无统计学意义(P>0.05)。结论预防性末端回肠造瘘术可降低吻合口瘘发生率,并可缩短患者术后首次排气时间、进食时间、住院时间,有利于患者术后恢复。

Objective To discuss the application value of prophylactic end ileostomy in stage Ⅰ resection of left colon cancer complicated with acute intestinal obstruction in the elderly. Methods The clinical data of 53 elderly patients with left colon cancer complicated with acute intestinal obstruction treated by stage Ⅰ resection and anastomosis were retrospectively analyzed. 25 patients with prophylactic end ileostomy were treated as group A, and 28 patients without prophylactic end ileostomy were treated as group B. Comparison were made on operation time, intraoperative bleeding volume, postoperative first exhaust time, feeding time, hospitalization time and the occurrence of anastomotic leakage between the two groups. Results Group A had postoperative first exhaust time, feeding time and hospitalization time respectively as(2.5±0.7),(3.0±0.8) and(9.0±2.0) d, which were significantly shorter than(4.0±0.7),(7.0±1.4) and(13.0±2.0) d in group B, and their difference was statistically significant(P<0.05). Group A had significantly lower incidence of anastomotic leakage as 4.0% than 28.6% in group B, and the difference was statistically significant(P<0.05). Conclusion Prophylactic end ileostomy can lower incidence of anastomotic leakage, shorten postoperative first exhaust time, feeding time, hospitalization time, and it helps recovery of patients after operation.