腹膜外斜隧道乙状结肠造口在腹腔镜Miles术中的应用

贾伟; 刘牧林; 朱冰; 骆杰

doi:10.16766/j.cnki.issn.1674-4152.001952

腹膜外斜隧道乙状结肠造口在腹腔镜Miles术中的应用

doi: 10.16766/j.cnki.issn.1674-4152.001952

蚌埠医学院第一附属医院胃肠外科，安徽蚌埠 233004

基金项目:

安徽省教育厅自然科学研究重点项目 KJ2017A219

详细信息

通讯作者:
骆杰，E-mail：13956391886@139.com

中图分类号: R735.37 R730.5
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出版历程
- 收稿日期: 2020-09-12
- 网络出版日期: 2022-02-16

Application of extraperitoneal oblique tunnel sigmoidostomy in laparoscopic Miles operation

Department of Gastrointestinal Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的研究腹膜外斜隧道式乙状结肠造口在经腹腔镜腹会阴联合直肠癌根治术中的临床应用价值。方法回顾性分析蚌埠医学院第一附属医院胃肠外科2015年1月—2017年12月行腹腔镜腹会阴联合切除(Miles)术的低位直肠癌患者104例的临床病例资料，其中观察组52例为经腹腔镜Miles术并行腹膜外斜隧道式乙状结肠造口患者，对照组52例为经腹腔镜Miles术并行腹膜内乙状结肠造口患者。随访24~60个月，统计分析2组患者术后造口首次排气时间、首次排便时间、术后住院时间、造口近期并发症(造口分离、造口水肿、造口缺血或坏死、造口肠管破裂、造口肠管梗阻)、造口远期并发症(造口回缩、造口狭窄、造口旁疝、造口脱垂)、术后第6个月排便感获得情况。结果观察组造口术后首次排气时间[(3.31±0.42)d]、首次排便时间[(4.18±0.55)d]高于对照组[(3.04±0.30)d、(3.93±0.42)d]，差异有统计学意义(均P < 0.05)；而术后住院时间观察组[(11.96±1.62)d]与对照组[(11.64±2.32)d]之间差异无统计学意义(P>0.05)。2组患者造口近期并发症发生率(15.385% vs. 17.308%)差异无统计学意义(P>0.05)，而造口远期并发症发生率(5.769% vs. 32.692%)、术后第6个月排便感获得率(86.538% vs. 40.385%)差异有统计学意义(均P < 0.05)。结论低位直肠癌患者行腹腔镜Miles术时采用腹膜外斜隧道式乙状结肠造口安全可行，并且能够明显减少术后造口远期并发症发生率，增加患者排便感获得率。
- 腹腔镜腹会阴联合切除术 /
- 低位直肠癌 /
- 乙状结肠造口 /
- 造口并发症
Abstract: Objective To investigate the clinical effect of extraperitoneal oblique tunnel sigmoidostomy in laparoscopic abdominoperineal radical resection of rectal cancer., Methods The clinical data of 104 patients with low rectal cancer who underwent laparoscopic abdominoperineal resection (Miles) from January 2015 to December 2017 in the First Affiliated Hospital of Bengbu Medical College were analysed retrospectively. Among them, 52 patients in the observation group were treated with laparoscopic Miles operation combined with extraperitoneal oblique tunnel sigmoidostomy, and 52 patients in the control group were treated with laparoscopic Miles operation combined with intraperitoneal sigmoidostomy. Follow-up was conducted for 24-60 months wherein the first time to exhaust time, the first defecation time, postoperative hospital stay, short-term complications (stoma separation, stoma edema, stoma ischemia or necrosis, stoma intestinal rupture, stoma intestinal obstruction), long-term complications (stoma retraction, stoma stenosis, parastomal hernia, stoma prolapse) and defecation feeling in the sixth month after operation) were statistically analysed. Results The first exhaust time [(3.31±0.42) d] and the first defecation time [(4.18±0.55) d] in the observation group were higher than those in the control group [(3.04±0.30) d] and [(3.93±0.42) d], and the difference was statistically significant (all P < 0.05). However, no significant difference was noted in postoperative hospital stay between the observation group [(11.96±1.62) d] and the control group [(11.64±2.32) d], P>0.05. No significant difference was observed in the short-term complication rate of stoma (15.385% vs. 17.308%) between the two groups (P>0.05) as well, but significant differences were noted in the long-term complication rate of stoma (5.769% vs. 32.692%) and the rate of defecation feeling in the sixth month after operation (86.538% vs. 40.385%) between the two groups (all P < 0.05). Conclusion Using extraperitoneal oblique tunnel sigmoidostomy in laparoscopic Miles operation is safe and feasible for patients with low rectal cancer. This approach can significantly reduce the incidence of long-term complications after stoma and increase the rate of defecation.
- Laparoscopic Miles surgery(Laparoscopic Abdominoperineal Resection) /
- Low rectal cancer /
- Sigmoid colostomy /
- Complications of stoma

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表 1 2组低位直肠癌患者术后一般情况比较(x ±s，d)

组别	例数	术后造口首次排气时间	术后造口首次排便时间	术后住院时间
观察组	52	3.31±0.42	4.18±0.55	11.96±1.62
对照组	52	3.04±0.30	3.93±0.42	11.64±2.32
t值		3.467	2.562	0.770
P值		0.001	0.013	0.445

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表 2 2组低位直肠癌患者术后造口近期并发症比较(例)

组别	例数	造口分离	造口水肿	造口缺血或坏死	造口肠管破裂	造口肠管梗阻	合计[例(%)]
观察组	52	1	5	1	0	1	8(15.385)
对照组	52	2	4	1	0	2	9(17.308)
注：2组并发症总发生率比较，χ²=0.070，P=0.791。

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表 3 2组低位直肠癌患者术后造口远期并发症比较(例)

组别	例数	造口回缩	造口狭窄	造口旁疝	造口脱垂	合计[例(%)]
观察组	52	0	1	2	0	3(5.769)
对照组	52	2	3	8	4	17(32.692)
注：2组并发症总发生率比较，χ²=12.133，P < 0.001。

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参考文献(20)

[1]	张现中, 刘忠臣. 低位直肠癌精准功能保肛(PPS)时代真的来了吗?——PPS在低位直肠癌保肛中的应用与研究[J]. 中华结直肠疾病电子杂志, 2020, 9(1): 2-6. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHZC202001002.htm
[2]	韩善亮, 方树青. 低位直肠癌保肛手术的外科治疗现状[J]. 浙江临床医学, 2016, 18(4): 766-768. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXDY200610034.htm
[3]	王雁军, 王青兵, 肖建安, 等. 腹膜外结肠造口在腹腔镜直肠癌Miles术中的应用[J]. 中华结直肠疾病电子杂志, 2016, 5(1): 56-59. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHZC201601012.htm
[4]	中华人民共和国国家卫生和计划生育委员会医政医管局. 中国结直肠癌诊疗规范(2017年版)[J]. 中国实用外科杂志, 2018, 38(10): 1089-1103. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201810001.htm
[5]	于周满, 杨军, 王淑春. 腹腔镜ELAPE术中乙状结肠腹膜外隧道造口的临床效果观察[J]. 中国现代普通外科进展, 2018, 21(4): 305-306, 329. https://www.cnki.com.cn/Article/CJFDTOTAL-PWJZ201804014.htm
[6]	成军, 李晓云, 晏伟, 等. 直肠癌腹腔镜腹会阴联合切除术腹膜外造口与腹膜内造口的比较[J]. 中国微创外科杂志, 2017, 17(12): 1080-1082. doi: 10.3969/j.issn.1009-6604.2017.12.008
[7]	吴金东, 高志斌, 江晓晖, 等. 腹膜外结肠造口在直肠癌Miles术中的应用效果[J]. 医学综述, 2017, 23(20): 4158-4161. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZS201720041.htm
[8]	刘桂芬, 张明霞. 经腹-会阴联合直肠癌根治术后经腹膜外造口对患者旁疝与排便功能的影响[J]. 中华疝和腹壁外科杂志(电子版), 2019, 13(6): 568-571. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFD201906022.htm
[9]	邱佩红, 谢红艳, 戎放. 肠造口患者自我感受负担与自我效能及生活质量相关性研究[J]. 中华全科医学, 2018, 16(9): 1570-1574. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201809045.htm
[10]	贾彩凤, 周慧洁, 黄伶俐. 肠造口患者术后生存质量影响因素的分析[J]. 浙江临床医学, 2020, 22(2): 280-282. https://www.cnki.com.cn/Article/CJFDTOTAL-DDZT201802001.htm
[11]	李小林, 张德雪, 赵海燕, 等. 认知行为疗法对结直肠癌永久性肠造口患者创伤后成长的影响[J]. 安徽医学, 2020, 41(2): 204-207. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYX202002026.htm
[12]	邱佩红, 谢红艳, 戎放. 肠造口患者自我感受负担与自我效能及生活质量相关性研究[J]. 中华全科医学, 2018, 16(9): 1570-1574. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201809045.htm
[13]	HAMADA M, OZAKI K, MURAOKA G, et al. Permanent end-sigmoid colostomy through the extraperitoneal route prevents parastomal hernia after laparoscopic abdominoperineal resection[J]. Dis Colon Rectum, 2012, 55(9): 963-969. http://www.onacademic.com/detail/journal_1000039413784910_a57c.html
[14]	刘宇, 黄海斌, 刘铜军. 经腹膜外乙状结肠造口在腹腔镜下腹会阴直肠癌手术中的疗效分析[J]. 中华普通外科杂志, 2019, 34(4): 358-360.
[15]	陈世杰, 刘秀兰, 彭超, 等. 腹会阴联合切除术两种乙状结肠造口对比分析[J]. 中国普外基础与临床杂志, 2016, 23(4): 462-466. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWL201604028.htm
[16]	殷凯, 瞿建国, 陈吉祥, 等. 腹腔镜直肠癌Mile's术腹膜外与腹膜内造瘘疗效对比[J]. 中国肿瘤外科杂志, 2018, 10(3): 150-152.
[17]	周海涛, 周志祥, 云红, 等. 腹腔镜腹会阴联合切除术中腹膜外隧道式乙状结肠造口的疗效分析[J]. 中国肿瘤临床与康复, 2016, 23(6): 641-644. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZK201606001.htm
[18]	陈洪亮, 李振军, 陈志良, 等. 腹膜外结肠造口在腹腔镜直肠癌Miles术中的临床应用[J]. 中国肛肠病杂志, 2015, 35(2): 17-19. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHZC201601012.htm
[19]	谭毓栓, 郑扶民, 叶舜宾. 普通外科学[M]. 长春: 吉林科学技术出版社, 1998: 270.
[20]	胡毕文, 曹晨曦, 沈桂鑫, 等. 直肠肛管恶性肿瘤腹会阴联合切除术中两种途径腹膜外乙状结肠造口的比较[J]. 浙江医学, 2016, 38(3): 198-200. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJYE201603014.htm