末端回肠造瘘在降低超低位直肠癌保肛术后吻合口漏发生中的作用

目的探讨末端回肠造瘘在降低超低位直肠癌保肛术后吻合口漏发生率中的作用。方法运用随机抽样的方法选取我院2013年1月—2014年9月收治的80例超低位直肠癌患者,依据治疗方法将这些患者分为研究组(n=40)和对照组(n=40)。给予对照组患者单纯保肛手术治疗,给予研究组患者保肛手术治疗基础上的末端回肠造瘘治疗,然后对患者的术中术后指标及并发症发生情况进行统计分析。结果研究组患者的术后进食时间、盆腔引流管拔除时间、肛门排气时间及住院时间均显著短于对照组(P0.05),吻合口漏及并发症发生率0、5.0%(2/40)均显著低于对照组10.0%(4/40)、20.0%(8/40)(P0.05)。结论末端回肠造瘘能够有效降低超低位直肠癌保肛术后吻合口漏发生率。     

低位直肠癌保肛术后吻合口瘘的护理

吻合口瘘是低位直肠癌保肛术后较常见的严重并发症。我院2005年5月-2008年10月行低位直肠癌保肛术316例,发生吻合口瘘15例,经及时发现,全身支持治疗,妥善护理,均取得满意的效果,现将护理体会总结如下。     

吻合器在中低位直肠癌保肛手术中的应用体会

我院于2001年2月～2006年12月应用国产吻合器技术施行中低位直肠癌前切除保留肛门手术（简称保肛术）67例，效果满意，现报告如下。     

低位直肠癌保肛手术72例分析

目的　探讨保留肛门手术 (sphinctersavingresection ,SSR)在低位直肠癌手术中的疗效。方法　对我院1998年 1月至 2 0 0 3年 10月 72例低位直肠癌保肛手术回顾性分析。结果　 72例保肛手术 6 6例一期愈合 ,6例术后出现吻合口瘘及吻合口狭窄。结论　保肛手术应综合分析判断 ,在保证根治的前提下 ,慎重选择病例 ,适当提高保肛手术率 ,提高患者的生活质量。     

低位直肠癌的保肛手术探讨

目的探讨超低位直肠癌保肛手术的可行性。方法回顾性分析1998~2004年我院行保肛手术和Miles术的低位直肠癌(距肛缘5~7cm)的临床资料。结果48例行保肛手术病人中,2年局部复发5例(5/48),2年和5年生存率分别为81.2%及60.4%。Miles组局部复发4例(4/47),2年和5年生存率分别为83.2%及59.6%。两组比较均无显著差异(P>0.05)。结论距肛缘5~7cm的低位直肠癌行保肛手术是可行的。     

低位直肠癌保肛手术的临床观察

目的 对低位直肠癌患者实施保肛手术,并观察临床治疗效果.方法 回顾性分析法是对实施保肛手术的低位直肠癌患者临床治疗资料进行分析的一种方法,本文采用这种方法对我院自2009年3月-2012年6月收治的40例病患资料进行分析,并观察患者临床治疗效果.结果 患者实施手术后有2例患者出现吻合口狭窄症状,1例患者出现吻合口瘘症状.实施手术一年后进行随访,发现患者对排便的控制能力评分均为优良,未发现复发病例,生活质量得到了显著提高.结论 手术方式对于患者生存质量而言具有重要性,低位直肠癌保肛手术对术后疗效的提高、并发症的降低具有重要作用与意义.     

低位直肠癌保肛手术的临床效果评价

[目的]探讨低位直肠癌保肛手术的临床治疗效果。[方法]选择某院2009年3月～2010年9月期间收治的低位直肠癌患者86例,随机将患者分为研究组和对照组,每组43例。两组患者经相关检查后,研究组患者行直肠癌前侧切除手术方案,而对照组患者则行腹会阴联合切除手术方案,并对两组患者的临床治疗效果等相关指标进行比较分析。[结果]与对照组患者相比,研究组患者的手术时间明显缩短,仅为162.45min;日排便次数明显减少,仅为3.23次;并发症发生率明显降低,仅为6.98%,差别均具有统计学意义(P﹤0.05);与此同时,研究组患者局部复发率明显降低,仅为6.98%;而5年生存率则明显提高,高达88.37%,差别均具有统计学意义(P﹤0.05)。[结论]低位直肠癌保肛手术疗效确切,效果显著,是低位直肠癌患者较为理想的治疗方法,值得进一步的临床推广和应用。     

低位直肠癌行保肛手术临床治疗分析

目的探讨低位直肠癌行保肛手术的临床治疗效果,为治疗低位直肠癌提供一定的临床指导。方法选取2009年1月至2012年1月来我院治疗低位直肠癌的患者40例进行回顾性分析,随机分成观察组和对照组两组,每组20例,观察组采用直肠癌前侧切除术(Dixon术)进行治疗,对照组采用传统腹会阴联合直肠癌根治术(Miles术)进行治疗,比较两组在治疗效果、排便次数、手术时间、并发症发生情况上的不同。结果观察组在治疗效果上明显优于对照组,在排便次数、手术时间、并发症发生率上明显低于对照组,存在统计学意义(p<0.05)。结论保肛手术治疗低位直肠癌能够显著提高患者的治疗效果,保证患者的生活质量,能够减少术后并发症,是一种科学有效的手术方法,在临床上可大力推广。     

低位直肠癌采用保肛手术治疗的临床疗效

目的:分析低位直肠癌采用保肛手术治疗的效果.方法:研究对象为我院随机选取的60例低位直肠癌患者,研究时间为2015年3月至2016年9月,研究对象分类为对照组、观察组,每组纳入30例患者.对照组行传统Mile手术治疗,观察组行保肛手术治疗,总结分析两组患者的最终治疗效果.结果:经保肛手术治疗,观察组治疗效果更接近预设值,与对照组相比,治疗有效率、治疗满意度、生活质量明确更为理想,P<0.05,存在统计学意义.结论:采用保肛手术治疗低位直肠癌患者能够较好改善患者的临床症状,提高患者的生活质量,并发症少,进而促进患者的恢复,应用价值较高.     

Quality of life in patients with a permanent stoma after rectal cancer surgery

Aim

Health-related quality of life (HRQoL) assessment is important in understanding the patient’s perspective and for decision-making in health care. HRQoL is often impaired in patients with stoma. The aim was to evaluate HRQoL in rectal cancer patients with permanent stoma compared to patients without stoma.

Methods

711 patients operated for rectal cancer with abdomino-perineal resection or Hartman’s procedure and a control group (n = 275) operated with anterior resection were eligible. Four QoL questionnaires were sent by mail. Comparisons of mean values between groups were made by Student´s independent t test. Comparison was made to a Swedish background population.

Results

336 patients with a stoma and 117 without stoma replied (453/986; 46 %). A bulging or a hernia around the stoma was present in 31.5 %. Operation due to parastomal hernia had been performed in 11.7 % in the stoma group. Mental health (p = 0.007), body image (p < 0.001), and physical (p = 0.016) and emotional function (p = 0.003) were inferior in patients with stoma. Fatigue (p = 0.019) and loss of appetite (p = 0.027) were also more prominent in the stoma group. Sexual function was impaired in the non-stoma group (p = 0.034). However in the stoma group, patients with a bulge/hernia had more sexual problems (p = 0.004). Pain was associated with bulge/hernia (p < 0.001) and fear for leakage decreased QoL (p < 0.001). HRQoL was impaired compared to the Swedish background population.

Conclusion

Overall HRQoL in patients operated for rectal cancer with permanent stoma was inferior compared to patients without stoma. In the stoma group, a bulge or a hernia around the stoma further impaired HRQoL.

     

保护性造口对直肠癌直肠低位前切除术器官腔隙感染的影响分析

 目的 了解保护性造口对行直肠低位前切除术（Dixon术）直肠癌患者术后器官腔隙感染的影响。方法 前瞻性监测2017-2021年某院实施Dixon术的直肠癌患者术后器官腔隙感染情况,分析感染危险因素,依据肿瘤距肛缘的距离将研究对象分为 ≥ 7 cm、5~7 cm和<5 cm三组,比较各组行保护性造口的比例及感染情况,以及行保护性造口与未行保护性造口患者的感染率。结果 2017-2021年该院行Dixon术的直肠癌患者器官腔隙感染率为4.79%（51/1 064）。危险因素分析显示,男性、术前贫血、术前肠梗阻、引流时间>10 d、肿瘤距肛门距离<7 cm、手术持续时间>3 h为发生器官腔隙感染的独立危险因素,而手术同时行保护性造口是发生器官腔隙感染的独立保护因素。肿瘤距肛门距离 ≥ 7 cm患者术后感染率最低,为2.76%;肿瘤距肛门5~7 cm患者感染率最高,为9.52%;肿瘤距肛门<5 cm患者行保护性造口比例最高,为72.05%。对于肿瘤距肛门距离 ≥ 7 cm患者,行保护性造口并不能有效预防感染的发生;对于肿瘤距肛门<5 cm患者,行保护性造口可明显降低感染率,差异有统计学意义（P=0.02）;肿瘤距肛门5~7 cm患者,行保护性造口后感染率降低幅度也很大,但差异无统计学意义（P=0.07）。结论 行保护性造口对直肠癌患者Dixon术后器官腔隙感染具有保护作用,尤其是对肿瘤距肛门距离<5 cm的患者。     

低位早期直肠癌经肛门局部切除术的临床应用

目的探讨低位早期直肠癌经肛门局部切除术的临床疗效。方法对28例低位早期直肠癌行经肛门局部切除术患者的临床资料进行回顾性分析。结果肿瘤侵犯肠壁的程度为Tis12例，T19例，T27例。28例标本切缘检查未见癌细胞残留。无手术死亡病例，手术后无直肠瘘、肛门失禁发生。术后2年无瘤生存率100％，3年存活率95．5％。结论低位早期直肠癌经肛门局部切除术，疗效确切，安全可行。     

低位直肠癌保肛术后复发的再治疗研究

目的 探讨低位直肠癌保肛术后复发的治疗方式及疗效.方法 保肛术后局部复发的低位直肠癌患者共56例,其中20例行根治手术(A组),21例行姑息手术加三维适形放射治疗(B组),15例单纯采用三维适形放射治疗(C组).结果 56例患者获随访6个月至3年,A组1、2、3年生存率分别为100.0%(20/20)、80.0%(16/20)、65.0%(13/20);B组分别为90.5%(19/21)、52.4%(11/21)、33.3%(7/21);C组分别为80.0%(12/15)、40.0%(6/15)、20.0%(3/15).A组的2、3年生存率明显高于B、C组(P<0.05).结论 对于低位直肠癌保肛术后复发的患者治疗首先应该选择根治手术,不能行根治手术的患者,可行姑息手术,术后进行三维适形放射治疗.

Abstract：

Objective To investigate the treatment of local recurrence after sphincter preserving surgery for low rectal cancer. Methods Fifty-six patients with local recurrence after sphincter preserving surgery for low rectal cancer were divided into three groups, 20 cases underwent radical resection (group A), 21 cases underwent palliative resection combined with 3 dimensional conformal radiation therapy (group B), and 15 cases only received 3 dimensional conformal radiation therapy (group C). Results All the patients were followed up from 6 months to 3 years. The 1-year,2-year and 3-year survival rates were 100.0%(20/20),80.0% (16/20),65.0% (13/20) in group A,90.5% (19/21),52.4% (11/21),33.3% (7/21) in group B and 80.0%(12/15),40.0%(6/15),20.0%(3/15) in group C respectively. Both 2-year and 3-year survival rates in group A were significantly higher than those in group B and group C (P <0.05). Conclusions The first choice of patients with local recurrence after sphincter preserving surgery for low rectal cancer is radical resection. Palliative resection combined with 3 dimensional conformal radiation therapy is the second choice.     

老年低位直肠癌保肛手术与腹会阴联合切除术疗效评价

目的探讨低位直肠癌保肛术与腹会阴联合切除术对病人术后并发症和肿瘤复发影响。方法随访2009年7—12月期间我院普外科手术治疗56例低位直肠癌,对保肛手术(LAR)与经腹会阴联合切除术(APR)两组病人的临床病理指标、术后并发症和局部复发状况进行统计学分析。结果 LAR组吻合口漏发生率明显较APR组高,差异有显著性(P<0.05),两组术后局部复发率比较,差异无统计学意义(P>0.05)。结论低位直肠癌保肛术与腹会阴联合切除术并不影响低位直肠癌病人术后肿瘤复发,但LAR较易发生吻合口瘘。     

Laparoscopic surgery for rectal cancer

Laparoscopic surgery for colonic cancer is a safe and established alternative to traditional open colectomy. The potential advantages of shorter length of stay, faster recovery and fewer operative complications are well documented. The last 5 years has seen an increase in the number of laparoscopic colorectal operations as more surgeons learn this technique. Short and medium term results have been encouraging with respect to oncological outcomes. However, laparoscopic surgery for rectal cancer remains a contentious issue. The increased complexity of operating within the confines of the pelvis and the greater risk of oncological compromise, have led to some surgeons urging caution. We present the challenges associated with laparoscopic rectal cancer surgery and explain that appropriate patient selection, surgical planning and laparoscopic experience are the key to successful outcomes.Laparoscopic surgery for cancer of the colon is a safe and well established technique in selected patients, when performed by trained and suitably experienced surgeons. Although several studies have documented the benefits of laparoscopic surgery compared with conventional open colectomy such as reduced blood loss, decreased hospital stay and less post-operative pain,^1,2 it is the equivalent oncological outcomes which have led to acceptance of a minimal access approach. However, laparoscopic resection for rectal cancer (defined as carcinoma within 15 centimetres of the anal verge) has not been as thoroughly evaluated and remains controversial.³ The main concern is fear of oncological compromise and that tumour clearance, and lymph node yields, as markers of surgical success may not be comparable with those achieved at open surgery. There is also a perceived risk of technical compromise due to the inflexibility of the instruments used during laparoscopy. This paper aims to highlight the potential benefits and challenges associated with laparoscopic rectal cancer surgery.     

腹腔镜下肠造口旁疝补片修补术的临床应用

目的 探讨腹腔镜下肠造口旁疝补片修补术的可行性.方法 对6例乙状结肠造口旁疝患者行腹腔镜下补片修补术.结果 6例患者均手术成功,手术时间90～136 min,住院时间5～9d,术后未出现严重的并发症,随访13～35个月,未发现复发病例.结论 腹腔镜下肠造口旁疝补片修补术在技术上是可行的,也是安全的,是传统治疗方法的补充.     

负压封闭引流术在预防直肠癌患者手术切口感染的临床分析

目的观察负压封闭引流术对预防直肠癌患者手术切口感染的临床效果,为直肠癌手术患者临床治疗提供依据。方法选取2012年1月-2015年1月南阳市中心医院诊治的直肠癌手术患者98例,随机分为试验组与对照组,每组各49例,对照组使用常规换药模式,试验组在对照组基础上使用负压封闭引流术,观察两组患者术后切口感染率、并发症发生率及切口愈合情况,数据采用SPSS16.0统计软件进行分析。结果患者术后切口感染率试验组为4.1%、对照组为18.4%,两组患者术后切口感染率比较,差异有统计学意义(P0.05);两组患者的切口愈合时间分别为(8.1±1.9)d和(11.5±2.8)d,换药次数分别为(2.5±1.8)次和(4.9±3.1)次,两组患者在愈合时间以及换药次数比较,差异有统计学意义(P0.05);两组患者均未发生切口裂开以及肿瘤种植等并发症,两组患者的并发症发生率比较,差异无统计学意义。结论负压封闭引流术能有效减少直肠癌手术患者切口感染,缩短患者的切口愈合时间,改善患者预后,提高患者生活质量,值得在临床直肠癌手术患者中推广使用。