预防性Y型造瘘在保护肠道高危吻合口中的临床应用
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摘要
目的探讨预防性Y型造瘘在保护肠道高危吻合口中的临床应用效果。方法选取2015年1月至2018年7月昆明医科大学第二附属医院收治的各类有肠道高危吻合口,予行预防性造瘘术,并于术后择期行造口还纳术的100例患者,其中预防性Y型造瘘50例作为观察组,传统袢式造瘘50例作为对照组。比较2组术后住院天数、肠瘘发生率、术后肠功能恢复时间、二次手术还纳手术时间、还纳术中出血量及切口感染率。结果相比对照组,观察组二次还纳手术时平均手术时间明显缩短,术中出血量显著减少,术后肠功能恢复时间较短,住院天数短,差异有统计学意义(P<0.05)。2组患者术后吻合口瘘发生率、还纳术后切口感染率、一次手术术后住院天数、一次手术肠功能恢复时间、造瘘维持时间差异无统计学意义(P>0.05)。结论存在肠道高危吻合口患者行预防性Y型造瘘术可有效降低吻合口瘘的发生,造口还纳时更加简单易行,创伤小,恢复快,无再次肠瘘发生,有临床应用价值。
Objective To explore the clinical application effect of preventive Y-type fistula in protecting intestinal high-risk anastomosis. Methods A total of 100 patients who were admitted to the first ward of gastrointestinal surgery of the second affiliated hospital of kunming medical university from January 2015 to July 2018 were selected for temporary fistulas and elective ostomyafter operation, 50 cases of prophylactic Y type fistulas were selected as observation group, and 50 cases with conventional loop fistulas were selected as control group. The postoperative hospital stay, the incidence of intestinal fistula, the recovery time of postoperative intestinal function, the time of second operation for reinstatement, the amount of blood loss, the incidence of intestinal fistula and the infection rate of incision were compared between the two groups. Results Compared with the control group, the average operation time of the observation group was shorter during the second reinstatement surgery,with less intraoperative hemorrhage, shorter postoperative recovery time of intestinal function, shorter postoperative hospitalization days, and no intestinal fistula, with statistically significant difference(P < 0.05).There were no statistically significant differences in the incidence of intestinal fistula, length of stay, duration of fistula repair, and wound infection rate between the two groups after the first operation(P > 0.05).Conclusions Preventive Y-shaped enterostomy can effectively reduce the occurrence of anastomotic fistula in patients with high risk of intestinal anastomotic fistula. It has the advantages of shorter operation time, less bleeding during operation, shorter hospital stay after operation, less pain in secondary operation and no recurrence of intestinal fistula. It has good clinical value.
Objective To explore the clinical application effect of preventive Y-type fistula in protecting intestinal high-risk anastomosis. Methods A total of 100 patients who were admitted to the first ward of gastrointestinal surgery of the second affiliated hospital of kunming medical university from January 2015 to July 2018 were selected for temporary fistulas and elective ostomyafter operation, 50 cases of prophylactic Y type fistulas were selected as observation group, and 50 cases with conventional loop fistulas were selected as control group. The postoperative hospital stay, the incidence of intestinal fistula, the recovery time of postoperative intestinal function, the time of second operation for reinstatement, the amount of blood loss, the incidence of intestinal fistula and the infection rate of incision were compared between the two groups. Results Compared with the control group, the average operation time of the observation group was shorter during the second reinstatement surgery,with less intraoperative hemorrhage, shorter postoperative recovery time of intestinal function, shorter postoperative hospitalization days, and no intestinal fistula, with statistically significant difference(P < 0.05).There were no statistically significant differences in the incidence of intestinal fistula, length of stay, duration of fistula repair, and wound infection rate between the two groups after the first operation(P > 0.05).Conclusions Preventive Y-shaped enterostomy can effectively reduce the occurrence of anastomotic fistula in patients with high risk of intestinal anastomotic fistula. It has the advantages of shorter operation time, less bleeding during operation, shorter hospital stay after operation, less pain in secondary operation and no recurrence of intestinal fistula. It has good clinical value.
引文
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[12]李菁,赵任.直肠癌低位前切除术后吻合口漏的诊断和防治[J].外科理论与实践,2010,15(03):308-312.
[13]周峰,张春霞,杜永红,et al.无支撑回肠造口在低位直肠切除术中应用的有效性和安全性分析[J].南京医科大学学报(自然科学版),2013,33(04):535-536.
[14]张军.肠造口还纳手术137例临床分析[J].临床医学,2014,34(07):29-30.
[15]舒杰,王歌,王华.“Y”型吻合预防吻合口瘘3例报告[J].昆明医科大学学报,2015,36(08):139-140.
[16]梁成芳.预防性回肠造口远端黏膜关闭术在腹腔镜直肠癌根治术中的应用效果[J].广西医学,2018,40(6):698-700.
[2]李世邦,刘牧林,孔令尚,等.我国直肠癌前切除术后发生吻合口瘘危险因素的Meta分析[J].中华普通外科学文献(电子版),2013,7(03):222-230.
[3]李利发,赵鑫,徐双兰,等.近五年腹腔镜直肠癌手术后吻合口漏危险因素的Meta分析[J].中华临床医师杂志(电子版),2015,9(13):2556-2563.
[4] BUCHS N C,GERVAZ P,SECIC M,et al. Incidence,consequences,and risk factors for anastomotic dehiscence after colorectal surgery:a prospective monocentric study[J]. Int J Colorectal Dis,2008,23(3):265-270.
[5]高利珍.吻合口位置及预防性回肠造瘘对直肠癌术后吻合口瘘的影响[J].中华普通外科杂志,2016,31(12):1015-1017.
[6]康青松,李飞波,马军波,等.急诊结肠造口术23例还纳要点分析[J].浙江创伤外科,2016,21(03):543-545.
[7]冯超.直肠癌前切除术术后吻合口漏的危险因素分析[J].南方医科大学学报,2011,31(5):908-910.
[8] PARK J S,CHOI G S,KIM S H,et al. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision:the Korean laparoscopic colorectal surgery study group[J]. Ann Surg,2013,257(4):665-671.
[9]欧阳军,赵晓春,李政,等l.末段回肠置管造口预防直肠前切除术后吻合口漏(附64例临床报道)[J].中国内镜杂志,2014,20(12):1280-1283.
[10]耿宏智.择期低位直肠癌前切除术预防性袢式回肠与结肠造瘘相关并发症的Meta分析[J].中华胃肠外科杂志,2014,17(11):1137-1141.
[11]PARTHASARATHY M,GREENSMITH M,BOWERS D,et al. Risk factors for anastomotic leakage after colorectal resection:a retrospective analysis of 17 518 patients[J].Colorectal Dis,2017,19(3):288-298.
[12]李菁,赵任.直肠癌低位前切除术后吻合口漏的诊断和防治[J].外科理论与实践,2010,15(03):308-312.
[13]周峰,张春霞,杜永红,et al.无支撑回肠造口在低位直肠切除术中应用的有效性和安全性分析[J].南京医科大学学报(自然科学版),2013,33(04):535-536.
[14]张军.肠造口还纳手术137例临床分析[J].临床医学,2014,34(07):29-30.
[15]舒杰,王歌,王华.“Y”型吻合预防吻合口瘘3例报告[J].昆明医科大学学报,2015,36(08):139-140.
[16]梁成芳.预防性回肠造口远端黏膜关闭术在腹腔镜直肠癌根治术中的应用效果[J].广西医学,2018,40(6):698-700.
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