预防性回肠造瘘在腹腔镜直肠癌低位吻合根治术中的应用价值及造口方式探讨
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摘要
目的研究预防性回肠造瘘在腹腔镜直肠癌低位吻合根治术中的应用价值。方法选择2012年5月～2017年12月收治的132例行低位吻合的直肠癌患者临床资料进行回顾性分析。所有患者均采用腹腔镜直肠癌低位吻合根治术,其中48例采用预防性改良襻式回肠末端造瘘(造瘘组),84例未采用预防性改良襻式回肠末端造瘘(未造瘘组)。对两组患者术中和术后情况进行比较研究。结果造瘘组患者术后恢复明显快于未造瘘组,造瘘组术后肛门排气时间、进食时间、拔除盆腔皮管时间、住院时间均明显短于未造瘘组,差异有统计学意义(P<0.05);造瘘组和未造瘘组患者吻合口瘘发生率分别为0和10.71%(9/84),差异有统计学意义(P<0.05);并发症发生率分别为16.67%(8/48)和21.43%(18/84),差异无统计学意义(P>0.05)。改良襻式回肠末端造瘘术具有造瘘时间短、造口并发症较少、造口回纳简单等优点。结论对腹腔镜直肠癌行低位吻合根治术患者施行预防性改良襻式回肠末端造瘘,能有效降低吻合口瘘的发生,有利于患者快速康复。改良襻式回肠末端造瘘术,操作简单实用,值得推广。
Objective To study the application value of preventive ileostomy in laparoscopic rectal cancer low anastomosis. Methods Clinical data of 132 patients with rectal cancer who were admitted to our hospital and were given low anastomosis from May 2012 to December 2017 were retrospectively analyzed. All patients were given laparoscopic rectal cancer low anastomosis. Among them, 48 patients were given preventive improved ileal terminal ostomy with a loop(ostomy group). 84 patients were not given preventive improved ileal terminal ostomy with a loop(non-ostomy group).A comparative study was performed between the two groups on intraoperative and postoperative conditions. Results The postoperative recovery of the patients in the ostomy group was significantly faster than that in the non-ostomy group.The anal exhaust time, eating time, pelvic tube removal time and length of hospital stay were significantly shorter in the ostomy group than those in the non-ostomy group(P<0.05); the incidence rate of anastomotic leakage was 0 and 10.71%(9/84) respectively in the ostomy group and non-ostomy group. and the difference was statistically significant(P<0.05);the complication rates were 16.67%(8/48) and 21.43%(18/84), respectively, and the difference was not statistically sig nificant(P>0.05). The improved ileal terminal ostomy with a loop has the advantages of short ostomy time, less ostomy complications, and simple ostomy return. Conclusion Preventive improved ileal terminal ostomy with a loop for the patients undergoing laparoscopic rectal cancer low anastomosis can effectively reduce the occurrence of anastomotic leakage and facilitate the rapid recovery of patients. Improved ileal terminal ostomy with a loop has simple and practical operation, which is worthy of promotion.
Objective To study the application value of preventive ileostomy in laparoscopic rectal cancer low anastomosis. Methods Clinical data of 132 patients with rectal cancer who were admitted to our hospital and were given low anastomosis from May 2012 to December 2017 were retrospectively analyzed. All patients were given laparoscopic rectal cancer low anastomosis. Among them, 48 patients were given preventive improved ileal terminal ostomy with a loop(ostomy group). 84 patients were not given preventive improved ileal terminal ostomy with a loop(non-ostomy group).A comparative study was performed between the two groups on intraoperative and postoperative conditions. Results The postoperative recovery of the patients in the ostomy group was significantly faster than that in the non-ostomy group.The anal exhaust time, eating time, pelvic tube removal time and length of hospital stay were significantly shorter in the ostomy group than those in the non-ostomy group(P<0.05); the incidence rate of anastomotic leakage was 0 and 10.71%(9/84) respectively in the ostomy group and non-ostomy group. and the difference was statistically significant(P<0.05);the complication rates were 16.67%(8/48) and 21.43%(18/84), respectively, and the difference was not statistically sig nificant(P>0.05). The improved ileal terminal ostomy with a loop has the advantages of short ostomy time, less ostomy complications, and simple ostomy return. Conclusion Preventive improved ileal terminal ostomy with a loop for the patients undergoing laparoscopic rectal cancer low anastomosis can effectively reduce the occurrence of anastomotic leakage and facilitate the rapid recovery of patients. Improved ileal terminal ostomy with a loop has simple and practical operation, which is worthy of promotion.
引文
[1]马从超,吴胜文.预防性造口在低位直肠癌前切除术中应用价值的Meta分析[J].中国现代普通外科进展,2012,15(12):963-967.
[2]王道荣,李清国,汤东,等.腹腔镜低位和超低位直肠癌保肛根治术中改良襻式回肠末端造瘘的应用价值[J].中华消化外科杂志,2013,12(5):362-365.
[3]Rondelli F,Reboldi P,Rulli A,et al.Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis:A meta-analysis[J].International Journal of Colorectal Disease,2009,24(5):479-488.
[4]Ulrich AB,Seiler C,Rahbari N,et al.Diverting stoma after low anterior resection:More arguments in favor[J].Dis Colon Rectum,2009,52(3):412-418.
[5]Tan WS,Tang CL,Shi L,et al.Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer[J].The British Journal of Surgery,2009,96(5):462-472.
[6]Montedori A,Cirocchi R,Farinella E,et al.Covering ileo-or colostomy in anterior resection for rectal carcinoma[J].Cochrane Database Syst Rev,2010,12(5):CD006878.
[7]Warschkow R,Steffen T,Thierbach J,et al.Risk factors for anastomotic leakage after rectal cancer resection and reconstruction with colorectostomy.A retrospective study with bootstrap analysis[J].Ann Surg Oncol,2011,18(10):2772-2782.
[8]崔伟,左富义,陈纲,等.预防性末端回肠造瘘对低位直肠癌保肛患者术后营养和功能状态的影响[J].临床军医杂志,2012,40(4):853-855.
[9]茆家定,吴佩,杨光,等.超低位直肠癌保肛手术的临床疗效及生存质量分析[J].实用医学杂志,2015,(16):2731-2734.
[10]El-Hussuna A,Lauritsen M,Bülow S.Relatively high incidence of complications after loop ileostomy reversal[J]Dan Med J,2012,59(10):A4517.
[11]Formijne Jonkers HA,Draaisma WA,Roskott AM,et al Early complications after stoma formation:A prospective cohort study in 100 patients with 1-yearfollow-up[J].Int J Colorectal Dis,2012,27(8):1095-1099.
[12]兰平,练磊.肠造口及其相关问题[J].中华胃肠外科杂志,2012,15(4):317-319.
[13]曾群章,方艺聪,郭银枞,等.从还纳术中探讨低位直肠癌保肛手术中预防性造口的选择[J].齐齐哈尔医学院学报,2016,21(37):2633-2635.
[14]谢江波,王姿欢,王一任.结直肠(结肠肛管)吻合术后袢式回肠造口与袢式横结肠造口比较的Meta分析[J]中南医学科学杂志,2013,41(5):453-459.
[15]陈进,邱明远,蒋恺,等.预防性回肠造瘘在70岁及以上老年低位直肠癌保肛术中的应用[J].中华老年医学杂志,2014,33(8):905-906.
[16]赵树展,郭澎,王昭顺,等.预防性回肠造瘘术在直肠癌根治术中的临床应用[J].实用癌症杂志,2016,31(4):625-627.
[17]王鸿鹄,徐昊,王振宁,等.低位直肠癌保肛患者行预防性回肠末端造瘘的优缺点[J].中华结直肠疾病电子杂志,2015,4(1):78-80.
[18]丁俊涛,张连阳,汪学伦,等.肠道暂时性造口与还纳方式及适应证选择90例分析[J/CD].中华普外科手术学杂志,2012,6(3):291-295.
[19]Bhangu A,Tiramula R.An evaluation of whether neoadjuvant therapy delays closure of defunctioning loop ileostomy following anterior resection for rectal cancer[J].Minerva Chir,2011,66(1):6649-6654.
[20]Chand M,Nash GF,Talbot RW.Timely closure of loop ileostomy following anterior resection for rectal cancer[J].European Journal of Cancer Care,2008,17(6):611-615.
[21]张骞,陈庆民,王锡山.预防性回肠造口在低位直肠癌中的应用[J].中华胃肠外科杂志,2016,19(4):469-471.
[2]王道荣,李清国,汤东,等.腹腔镜低位和超低位直肠癌保肛根治术中改良襻式回肠末端造瘘的应用价值[J].中华消化外科杂志,2013,12(5):362-365.
[3]Rondelli F,Reboldi P,Rulli A,et al.Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis:A meta-analysis[J].International Journal of Colorectal Disease,2009,24(5):479-488.
[4]Ulrich AB,Seiler C,Rahbari N,et al.Diverting stoma after low anterior resection:More arguments in favor[J].Dis Colon Rectum,2009,52(3):412-418.
[5]Tan WS,Tang CL,Shi L,et al.Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer[J].The British Journal of Surgery,2009,96(5):462-472.
[6]Montedori A,Cirocchi R,Farinella E,et al.Covering ileo-or colostomy in anterior resection for rectal carcinoma[J].Cochrane Database Syst Rev,2010,12(5):CD006878.
[7]Warschkow R,Steffen T,Thierbach J,et al.Risk factors for anastomotic leakage after rectal cancer resection and reconstruction with colorectostomy.A retrospective study with bootstrap analysis[J].Ann Surg Oncol,2011,18(10):2772-2782.
[8]崔伟,左富义,陈纲,等.预防性末端回肠造瘘对低位直肠癌保肛患者术后营养和功能状态的影响[J].临床军医杂志,2012,40(4):853-855.
[9]茆家定,吴佩,杨光,等.超低位直肠癌保肛手术的临床疗效及生存质量分析[J].实用医学杂志,2015,(16):2731-2734.
[10]El-Hussuna A,Lauritsen M,Bülow S.Relatively high incidence of complications after loop ileostomy reversal[J]Dan Med J,2012,59(10):A4517.
[11]Formijne Jonkers HA,Draaisma WA,Roskott AM,et al Early complications after stoma formation:A prospective cohort study in 100 patients with 1-yearfollow-up[J].Int J Colorectal Dis,2012,27(8):1095-1099.
[12]兰平,练磊.肠造口及其相关问题[J].中华胃肠外科杂志,2012,15(4):317-319.
[13]曾群章,方艺聪,郭银枞,等.从还纳术中探讨低位直肠癌保肛手术中预防性造口的选择[J].齐齐哈尔医学院学报,2016,21(37):2633-2635.
[14]谢江波,王姿欢,王一任.结直肠(结肠肛管)吻合术后袢式回肠造口与袢式横结肠造口比较的Meta分析[J]中南医学科学杂志,2013,41(5):453-459.
[15]陈进,邱明远,蒋恺,等.预防性回肠造瘘在70岁及以上老年低位直肠癌保肛术中的应用[J].中华老年医学杂志,2014,33(8):905-906.
[16]赵树展,郭澎,王昭顺,等.预防性回肠造瘘术在直肠癌根治术中的临床应用[J].实用癌症杂志,2016,31(4):625-627.
[17]王鸿鹄,徐昊,王振宁,等.低位直肠癌保肛患者行预防性回肠末端造瘘的优缺点[J].中华结直肠疾病电子杂志,2015,4(1):78-80.
[18]丁俊涛,张连阳,汪学伦,等.肠道暂时性造口与还纳方式及适应证选择90例分析[J/CD].中华普外科手术学杂志,2012,6(3):291-295.
[19]Bhangu A,Tiramula R.An evaluation of whether neoadjuvant therapy delays closure of defunctioning loop ileostomy following anterior resection for rectal cancer[J].Minerva Chir,2011,66(1):6649-6654.
[20]Chand M,Nash GF,Talbot RW.Timely closure of loop ileostomy following anterior resection for rectal cancer[J].European Journal of Cancer Care,2008,17(6):611-615.
[21]张骞,陈庆民,王锡山.预防性回肠造口在低位直肠癌中的应用[J].中华胃肠外科杂志,2016,19(4):469-471.