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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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

Received: 04 November 2019

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	ZHU Xuequn
	WANG Dongjie
	LI Xiang
	ZHANG Baihao

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

[1] CHEN J, WANG D R, YU H F, at al. Defunctionging stoma in low anterior resection for rectal cancer: a meta-analysis of five recent studies[J]. Hepatogastroenterology, 2012, 59(118): 1828-1831.
[2] RAHBARI N N, WEITZ J, HOHENBERGER W, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the intemational study group of rectal cancer[J]. Surgery, 2010, 147: 339-351.
[3] SHOGAN B D, CARLISLE E M, ALVERDY J C, et al. Do we really know why colorectal anastomoses leak?[J]. J Gastrointest Surg, 2013, 17(9): 1698-1707.
[4] 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): 625627.
[5] SHIOMI A, ITO M, MAEDA K, et al. Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: A propensity score matching analysis of 1 014 consecutive patients[J]. J Am Coll Surg, 2015, 220(2): 186-194.
[6] MANSFILED S D, JENSEN C, PHAIR A S, et al. Complications of loop ileostomy closure: a retrospective cohort analysis of 123 patents[J]. World J Surg, 2008, 32(9): 21012106.
[7] SALVADALENA G. Incidence of complications of the stoma and peristomal skin among individuals with colostomy, ileostomy, and urostomy: a systematic review[J]. J Wound Ostomy Continence Nurs, 2008, 35(6): 596-607.
[8] QU H, LIU Y, BI D S. Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis[J]. Surg Endosc, 2015, 29(12): 3608-3617.
[9] VAXMAN F, IONESCU C, VOLKMAR P, et al. The unopened colostomy: a procedure to protect colonic anastomosis[J]. Int J Colorectal Dis, 1993, 8(1): 48-50.
[10] WOODCOCK, QURESHI, MACFIE. The unopened loop ileostomy[J]. Colorectal Dis, 2000, 2(2): 97-99.
[11] 张前进, 胡远超, 张敏康, 等. 末端回肠外置术在腹腔镜直肠癌前切除术中应用的可行性[J]. 中华胃肠外科杂志, 2015, 18(5): 450-453.
[12] 刘德林, 吴昌德, 单留群, 等. 免回纳回肠造口分析[J]. 中华临床医师杂志(电子版), 2015, 9(5): 869-871.