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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