末段回肠预置腹壁下在腹腔镜直肠癌前切除术中的应用

doi:10.3969/j.issn.2095-9400.2020.05.014

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摘要目的：分析末段回肠预置腹壁下（不造口）在腹腔镜直肠癌前切除术中应用的可行性，为临床工作提供依据。方法：选取2013年12月至2018年5月收治的196例直肠癌患者作为研究对象，将所有患者随机分为预置组和造口组，每组98例，预置组实施腹腔镜直肠癌前切除术+末段回肠预置腹壁下，造口组实施腹腔镜直肠癌前切除术+保护性末段回肠造口，比较2组患者住院费用、手术时间、住院时间、术后吻合口瘘、肠梗阻、造口及造口还纳相关并发症的发生率。结果：预置组患者住院费用低于造口组，预置组患者手术时间和住院时间短于造口组，差异均有统计学意义（ P ＜0.05）；预置组和造口组患者分别有5例和6例出现术后吻合口瘘，差异无统计学意义（ P =0.611）；预置组和造口组患者各有10例出现肠梗阻，肠梗阻发生率差异无统计学意义（ P =0.824）；预置组和造口组患者分别有1例和21例出现造口及造口还纳相关并发症，差异有统计学意义（ P =0.008）。结论：末段回肠预置腹壁下，能减少腹腔镜直肠癌前切除术手术相关并发症，且不会增加发生吻合口瘘的风险，安全可行。

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关键词 ：末端回肠, 回肠造口, 腹腔镜, 直肠前切除术, 吻合口瘘

Abstract：Objective: To analyze the preposition of distal ileum under the abdominal wall (without ileostomy) in laparoscopic anterior resection of rectal cancer. Methods: From December 2013 to May 2018, a total of 196 cases of rectal cancer patients in our hospital were collected as subjects, who were randomly divided as preset group and ileostomy group with 98 cases in each group. The preset group received undergoing laparoscopic anterior resection for low rectal cancer+distal ileum preposition under the abdominal wall, while the ileostomy group undergoing laparoscopic anterior resection for low rectal cancer+terminal ileum protective ileostomy. Two groups were compared in the hospital expenses (including return ileum), operation time (including return ileum), length of hospital stay (including return ileum), postoperative anastomotic fistula, intestinal obstruction, the incidence of ileostomy and return ileum related complications. Results: Compared with the ileostomy group, the preset group had lower hospitalization cost, shorter operation time and shorter length of hospital stay, all showing statistical significance (P<0.05). Postoperative anastomotic fistula occurred in 5 patients in the preset group and 6 patients in the ileostomy group, respectively. There was no statistical difference in the incidence of postoperative anastomotic fistula between the preset group and the ileostomy group (P=0.611). There were 10 cases of intestinal obstruction in the preset group and the ileostomy group, respectively. There was no statistical difference in the incidence of postoperative intestinal obstruction between the preset group and the ileostomy group (P=0.824). There were 1 case and 21 cases in the preset group and the ileostomy group, respectively, showing ileostomy and return ileum related complications., and the incidence rate of ileostomy and return ileum related complications in the preset group was significantly lower than that of the ileostomy group (P=0.008). The difference was statistically significant. Conclusion: The application of distal ileum preposition under the abdominal wall can reduce complications related to laparoscopic rectal resection of rectal cancer without increasing the risk of anastomotic leakage.

Key words： distal ileum ileostomy laparoscopy anterior resection anastomotic fistula

收稿日期: 2019-11-04

作者简介: 朱学群（1975-），男，湖北咸宁人，副主任医师，硕士。

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https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2020.05.014 或 https://xb.wmu.edu.cn/CN/Y2020/V50/I5/419

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