盲肠插管造瘘术预防结直肠术后吻合口漏的应用

目的探讨盲肠插管造瘘术在预防结直肠术后吻合口漏的作用。方法采用病例对照研究,研究组73例,其中因直肠癌行前切除术41例,乙状结肠癌并慢性不全性梗阻20例,均行乙状结肠癌根治性Ⅰ期切除吻合,因左半结肠癌合并急性梗阻行Ⅰ期切除吻合10例,成人巨结肠并梗阻2例,均行Ⅰ期切除吻合;对照组87例,其中因直肠癌行前切除56例,乙状结肠癌并慢性不全性梗阻31例,均行乙状结肠癌根治性Ⅰ期切除吻合。研究组均行经阑尾残端盲肠造瘘;对照组未予预防性插管。结果研究组术后进食时间和住院时间分别为(3.3±0.4)d和(20.2±4.0)d,均明显短于对照组的(4.6±0.9)d和(29.1±5.5)d,两组比较差异显著(P0.05)。研究组术后发生吻合口漏1例(1.4%);对照组发生10例(11.5%),两组比较有统计学差异(P0.05)。结论盲肠插管造瘘术在预防结直肠手术后吻合口漏方面具有简单、方便、有效、可行的优势。

The Application of Cecostomy by Appendiceal Stump Intubation for Prevention of the Anastomotic Leakage after Colorectal Surgery

Objective To investigate the effect of cecostomy by appendiceal stump intubation on the prevention of the anastomotic leakage after colorectal surgery.Methods A retrospective case-control study was used.In the study group,73 cases were enrolled including 41 cases of rectum carcinoma underwent anterior resection,20 cases of sigmoid carcinoma,10 cases of left half colon cancer,2 cases of adult congenital dilatation of colon,all the last 32 cases combined with incomplete intestinal obstruction and underwent radical resection with one-stage intestinal anastomosis.In the study group,all the patients were given prophylactic cecostomy by appendiceal stump intubation.And in the control group,there were 87 cases enrolled,including 56 cases of rectum carcinoma underwent anterior resection,and 31 cases of sigmoid carcinoma combined with incomplete intestinal obstruction underwent radical resection with one-stage intestinal anastomosis.All the 87 cases in the control group were not operated with prophylactic stoma.Results The jejunitas time and hospital stay was（3.3±0.4）days and（20.2±4.0）days in the study group,and was（4.6±0.9）days and（29.1±5.5）days in the control group respectively,which showed significant differences between the two groups（P〈0.05）.And anastomotic leakage was found in 1 case in the study group,and 10 cases in the control group with significant difference（P〈0.05）.Conclusion The prophylactic cecostomy by appendiceal stump intubation is a simple and practical way to prevent anastomotic leakage after colorectal surgery.