文章摘要
低位直肠癌根治术后预防性回肠造口方式对转流性结肠炎发病率及转归的影响*
Effect of Preventive ileostomy on incidence rate of diversion colitis and outcome of patients after radical resection of low rectal cancer
投稿时间:2020-03-12  修订日期:2020-03-17
DOI:
中文关键词: 转流性结肠炎  回肠造口术  发病率  生活质量  直肠肿瘤
英文关键词: diversion colitis  ileostomy  incidence rate  quality of life  rctal neoplasms
基金项目:国家自然科学基金国际科技合作项目(2013DFA32110)
作者单位E-mail
吴迪 空军军医大学唐都医院 普通外科 182092039@qq.com 
王楠 空军军医大学唐都医院 普通外科  
吴涛 空军军医大学唐都医院 普通外科  
张战胜 空军军医大学唐都医院 普通外科  
张波 空军军医大学唐都医院 普通外科  
杨振宇 空军军医大学唐都医院 普通外科  
韦明光 空军军医大学唐都医院 普通外科  
杨世荣 空军军医大学唐都医院 普通外科  
高鹏 空军军医大学唐都医院 普通外科  
乔庆 空军军医大学唐都医院 普通外科  
何显力 空军军医大学唐都医院 普通外科 Email: wanghe@fmmu.edu.cn 
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中文摘要:
      目的:比较行预防性回肠单腔或双腔造口术对转流性结肠炎发病率及转归的影响。方法:回顾2016年1月至2019年7月于我院接受腹腔镜低位直肠癌根治术+预防性回肠造口术的病例,按入排标准从中选取52例,根据造口方式不同分为单腔组(24例)和双腔组(28例),收集两组患者的临床基本资料、I/II期手术的手术情况及术后短期疗效、造口后3-4月及造口还纳后4-6月内镜下结肠水肿、出血、接触性出血情况及转流性结肠炎相关症状(失功能肠段浆液、粘液、血性分泌物、腹痛、里急后重、腹泻)发生情况。结果:两组患者术前资料具有可比性;除双腔组造口还纳手术时间低于单腔组外(50.00±9.33 min vs.64.79±8.01 min,P<0.05),两组患者I/II期手术的手术时间、造口还纳时间、术中出血量、肠道功能恢复时间、住院时间及术后近期并发症的发生均无统计学意义;双腔组患者转流性结肠炎发病率显著少于单腔组,差异有统计学意义(46.4% vs.87.5%,P<0.05);双腔组患者中重度转流行结肠炎比例低,严重程度低于单腔组,差异有统计学意义(23.1%vs.57.1%,P<0.05);单腔组患者造口还纳后腹泻发生率高于双腔组,差异有统计学意义(33.3% vs.7.1%,P<0.05)。结论:预防性回肠单腔造口与双腔造口均安全可行。与回肠单腔造口相比,双腔造口导致的转流性结肠炎发病率低、严重程度低、腹泻发生率低、生活质量较高。为预防转流性结肠炎的发生及提高患者生活质量,预防性回肠双腔造口术更具优势,具有良好的临床应用前景。
英文摘要:
      ABSTRACT Objective:To compare the effect of preventive ileostomy with single or double lumen on the incidence and outcome of diversion colitis. Methods: From January 2016 to July 2019, 52 cases of laparoscopic low rectal cancer radical operation + preventive ileostomy in our hospital were reviewed. According to the inclusion criteria, 52 cases were divided into the single lumen group (24 cases) and the double lumen group (28 cases). The basic clinical data of the two groups, the operation situation of stage I / II operation, the short-term effect after operation, the occurrence of colon edema, bleeding, contact bleeding and symptoms related to diversion colitis (fluid, mucus, blood secretion, abdominal pain, urgency, diarrhea) 3-4 months later after the ostomy and 4 - 6 months later after the stoma closure were observed. Results: the preoperative data of the two groups were comparable, except that the operation time of double lumen group was lower than that of single lumen group (50.00 ± 9.33 min vs.64.79 ± 8.01 min, P < 0.05). There was no statistical significance in the operation time, stoma closure time, intraoperative bleeding volume, intestinal function recovery time, hospitalization time and recent postoperative complications of the two groups. The incidence of diversion colitis in the double lumen group was significantly lower than that in the single lumen group(46.4% vs.87.5%,P<0.05); There was a significant difference in severity of diversion colitis between the two groups(23.1%vs.57.1%,P<0.05);The incidence of diarrhea in the single lumen group was higher than that in the double lumen group (33.3% vs.7.1%, P < 0.05). Conclusion: preventive ileostomy is safe and feasible. Compared with single lumen ileostomy, double lumen ileostomy leads to low incidence of diversion colitis, low severity, low incidence of diarrhea and high quality of life. In order to prevent the occurrence of diversion colitis and improve the quality of life of the patients, preventive ileostomy has more advantages and good clinical application prospects.
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