| 末端回肠自闭插管保护性造口在结直肠手术中的应用 |
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| 引用本文： | 童锋,应佑华,蒋文良,潘海华,赵伟,李红晨. 末端回肠自闭插管保护性造口在结直肠手术中的应用[J]. 中华全科医学, 2016, 14(11): 1876-1879. DOI: 10.16766/j.cnki.issn.1674-4152.2016.11.027 |
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| 作者姓名： | 童锋 应佑华 蒋文良 潘海华 赵伟 李红晨 |
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| 作者单位： | 兰溪市人民医院普外科, 浙江 兰溪 321100 |
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| 基金项目： | 浙江省兰溪市科技局项目(2013C07) |
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| 摘 要： | 目的 探讨末端回肠自闭插管保护性造口术在结直肠手术中预防吻合口漏的可行性和安全性。 方法 回顾性分析2011年5月—2015年12月兰溪市人民医院收治的结直肠手术中合并行保护性造口病例106例，分为2组，插管组行末端回肠自闭插管保护性造口术83例，传统组行传统回肠或横结肠中段襻式造口术23例，观察比较2组患者术后并发症、营养及感染相关指标(总蛋白、白蛋白、前白蛋白、C反应蛋白、降钙素原等)、肠道再通时间、经济性等。 结果 2组造口方法对结直肠术后吻合口均有保护作用，2组吻合口漏发生率、术后7 d感染及术后14 d营养指标差异无统计学意义。插管组肠道再通时间平均19 d,传统组肠道再通时间平均125 d,插管组肠蠕动恢复及造口排便时间明显早于传统组，造口旁疝、肠梗阻等并发症明显少于传统组。住院时间及费用明显低于传统组。 结论 针对高龄，营养不良，存在糖尿病等合并症，术前接受新辅助放化疗，低位直肠癌行保肛手术的患者；术中吻合情况不满意；左半结直肠癌合并急性梗阻，左半结肠、直肠急性损伤等肠道准备不满意患者适用保护性造口术。末端回肠自闭插管保护性造口术与传统回肠或横结肠中段襻式造口术比较，不但有着相同的预防吻合漏作用，而且明显缩短住院时间，避免二期回纳手术，减轻患者痛苦，降低住院费用。
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| 关 键 词： | 结直肠手术 保护性造口术 吻合口漏 |
| 收稿时间： | 2016-03-20 |
The application of protective stoma in the terminal ileum with self-closing intubation in colorectal surgery |
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| Affiliation: | Department of General Surgery, Lanxi People's Hospital, Lanxi, Zhejing 321100, China |
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| Abstract: | Objective To investigate the feasibility and safety of the spontaneously closed protective stoma at the terminal ileum to prevent anastomotic leakage in colorectal surgery. Methods A retrospective analysis of 106 cases of colorectal surgery with protective stoma patients from May,2011 to December,2015 in Lanxi People's Hospital.They were divided into two groups:83 cases with spontaneously closed protective stoma at the terminal ileum and 23 cases with conventional loop ileostomy or loop transverse colostomy.Two groups were compared for the following indicators:postoperative complications,nutrition and infection-related indicators(TP,Alb,PA,CRP,PCT and so on),intestinal repatency time,hospitalization costs and so on. Results Two protective stoma methods all have a protective effect on colorectal anastomoses.There was no statistically significant difference in anastomotic leakage rate,the incidence of postoperative infection in 7 days in addition to nutrition indicators in 14 days.The average intestinal repatency time of the spontaneously closed protective stoma group is 19 d,while the conventional group is 125 d.The recovery of enterokinesia and defacation of the spontaneously closed protective stoma group was significantly earlier than that of the conventional group;meanwhile,parastomal hernia,intestinal obstruction and other complications of the experimental groupwere significantly less than the conventional group.Hospitalization time and costs of the experimental group were significantly lower than the conventional group. Conclusion For the patients with advanced age,malnutrition,diabetes and other complications,receiving neoadjuvant chemotherapy before operation,anus-retained operation for low rectal cancer,and the patients was unsatisfied with intraoperative anastomoses,left colorectal cancer complicated by acute obstruction,acute injury of left colon or rectum and other patients dissatisfied with intestinal tract preparation are suitable for protective stoma.Compared with conventional loop ileostomy or loop transverse colostomy,spontaneously closed protective stoma has the same effect of preventing anastomotic leakage,and can shorten hospitalization time,avoid 2nd stage operation,ease patients' pain and reduce hospitalization costs. |
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