回肠双腔造口对中低位直肠癌前切除术后转流性结肠炎的发生及疾病转归的影响

目的 探究回肠双腔造口对中低位直肠癌前切除术后转流性结肠炎的发生及疾病转归的影响。方法 回顾性分析223例2011年6月至2021年6月就诊于铜陵市人民医院胃肠外科接受预防性回肠造口和中低位直肠癌切除术的老年患者病例资料。根据造口方式分为单腔造口组(101例)和双腔造口组(122例),收集分析两组临床资料，分析造口后3～4个月和造口还纳术后6个月结肠镜结果及临床症状资料。采用Logistic回归分析影响转流性结肠炎的危险因素。结果 单腔造口组肠道恢复时间和术后并发症发生率显著高于双腔造口组(P<0.05);造口术后3～4个月，单腔造口组转流性结肠炎中、重度及临床症状发生率均显著高于双腔造口组(P<0.05);造口还纳术6个月后，单腔造口组转流性结肠炎严重程度、临床症状发生率均显著高于双腔造口组(P<0.05);Logistic回归分析显示，造口方式的不同是影响回肠造口术后发生转流性结肠炎及转归的危险因素。结论 回肠双腔造口能够降低中低位直肠癌前切除术后转流性结肠炎的发生率，并促进转流性结肠炎的转归。     

老年人低位直肠癌前切除术后回肠置管造口与横结肠造口的对比研究

目的 对比研究回肠置管造口术与横结肠造口术对老年低位直肠癌患者施行前切除术(LAR)后发生吻合口漏的预防和治疗特点.方法 选择低位直肠癌患者施行LAR后具有发生吻合口漏高危因素的老年患者60例,随机分为横结肠造口组与回肠置管造口组.观察吻合口漏的发生率、住院时间和费用.结果 两组各发生吻合口漏1例,均经非手术治疗痊愈.住院时间和费用横结肠造口组为17 d,2.8万元;回肠置管造口组为18 d,2.9万元,两组比较差异无统计学意义(均为P＞0.05).结论 回肠置管造口术对LAR手术后发生吻合口漏的预防和治疗作用与横结肠造口术无差异,是一项简单、安全、有效的方法.     

一针法预防性回肠造口在直肠癌低位前切除手术中的应用

目的探讨一针法回肠造口方法在直肠癌低位前切除手术中的技术优势。 方法前瞻性分析2016年1月至2019年1月河南省肿瘤医院普外科连续80例行直肠癌低位前切除并预防性回肠造口手术的患者,按随机表法分为一针法回肠造口组（观察组）和传统方法造口组（对照组）,对比两组造口手术操作时间、造口皮肤黏膜分离、粪水性皮炎、造口旁疝、造口脱垂、造口回缩等相关造口并发症指标的发生率。 结果两组患者的基线资料比较差异无统计学意义（均P>0.05）,观察组手术操作时间短于对照组［（2.1±0.9）min vs.（15.2±4.6）min］（t=-17.510,P<0.05）,造口皮肤黏膜分离、粪水性皮炎、造口回缩等发生率与传统方法组比较差异均有统计学意义（观察组造口皮肤黏膜分离患者1例,对照组15例;观察组粪水性皮炎患者3例,对照组32例;观察组造口回缩患者0例,对照组8例）（χ²=15.313,42.717,8.889;P均<0.05）,在造口旁疝、造口脱垂两方面差异无统计学意义（观察组造口旁疝患者2例,对照组6例;观察组造口脱垂患者2例,对照组3例）（χ²=2.222,0.213;P均>0.05）。 结论一针法回肠造口在直肠癌低位前切除术中较传统方法更具操作优势,而且可减少相关造口并发症的发生。     

经预防性造口标本取出的腹腔镜直肠癌前切除术

目的评价经预防性小肠造口切口标本取出的腹腔镜直肠癌前切除术的安全性和可行性。 方法回顾分析13例中低直肠癌患者行术前同步放化疗,休息6至12周后行腹腔镜直肠癌低位前切除术联合末端回肠造口术,按TME原则行前切除术,远端肠管应用腔内型直线切割吻合器闭合切断,经右下腹纵切口3～4 cm将标本及近端直肠乙状结肠提出腹壁,清扫系膜淋巴结切除标本,镜下完成吻合,然后经右下腹切口完成预防性小肠造口。 结果13例患者均顺利完成手术,手术时间140 min(115～165 min),术中出血量27.7 ml(10～50 ml),进流食时间1.6 d(1～3 d),术后出院时间6.9 d(5～8 d),术后疼痛评分3.6(2.5～5),无手术死亡及严重并发症发生。 结论在需行预防性造口的腹腔镜直肠癌前切除术患者中,经造口切口标本取出手术方式是安全可行的。     

直肠癌前切除术后预置回肠造口与袢式回肠造口的对比研究

目的评估预置回肠造口（末段回肠预置于腹壁下）对比袢式回肠造口在腹腔镜直肠癌前切除术中的优势。 方法进行前瞻性研究,纳入2020年1月至2021年12月甘肃省人民医院肛肠科收治的行腹腔镜直肠癌前切除术的患者,分为预置回肠造口组及袢式回肠造口组。主要的研究终点：首次住院以及术后3个月总体并发症指数（CCI）;次要研究终点：术后吻合口漏发生率、肠梗阻发生率、手术时间、住院时间、住院费用、并发症Clavien-Dindo分级、术后3个月再次住院率以及肛门直肠功能（Wexner评分）;其他研究终点：术后通气时间、首次进食时间、术后腹泻、手术时间＞3 h、切缘阳性率以及术后病理pTNM分期。 结果预置回肠造口组对比袢式回肠造口组的首次住院总体并发症评分（CCI评分）为（25.3±7.1 vs. 26.4±5.7）,差异无统计学意义（t=0.456,P=0.067）,而预置回肠造口组对比袢式回肠造口组术后3个月的CCI评分为（26.2±6.2 vs. 31.7±9.1）,差异有统计学意义（t=0.283,P=0.041）。此外,预置回肠造口组患者对比袢式回肠造口组患者在手术时间（Z=-2.646,P=0.008）、住院时间（Z=-3.564,P=0.034）、住院费用（Z=-5.118,P=0.021）、术后3个月再次住院率（χ²=25.652,P=0.001）、术后3个月肛门直肠功能（t=-3.128,P=0.003）以及并发症Clavien-Dindo分级（χ²=9.692,P=0.021）等方面差异均具有统计学意义。 结论预置回肠造口相对于袢式回肠造口是一种安全可行且经济有效的术式,但仅限于中低危吻合口漏患者。此外,本研究样本量较少且随访时间短,仍需后续试验加以验证。     

低位直肠癌保肛手术中回肠襻式造口与改良自闭式造口的对比研究

目的探讨低位直肠癌保肛手术中应用改良自闭式造口的安全性和有效性,比较采用改良自闭式造口与回肠襻式造口两种造口方式的临床疗效。 方法回顾性分析苏北人民医院胃肠外科2016年9月~2018年8月期间60例行低位直肠癌保肛手术患者的临床资料,根据预防性造口实施方式的不同分为：改良自闭式造口组25例,回肠襻式造口组35例。分析指标包括：一般资料及病理资料、术中及术后恢复情况、术后并发症及随访情况。 结果两组患者均未发生吻合口漏,改良自闭式造口组患者术后总住院时间为（8.68±0.95）天,回肠襻式造口组患者术后总住院时间为（14.46±1.20）天,两组比较差异具有统计学意义（t=13.00,P<0.01）,包括行一期造口及二期还纳手术的时间。改良自闭式造口组患者在院总花费为（59 284.52±5 712.63）元,回肠襻式造口组为（75 128.77±10 238.05）元,两组比较差异具有统计学意义（t=6.99,P<0.01）。 结论相比回肠末端襻式造口,改良自闭式造口住院时间少、住院费用低,避免了造口旁疝及造口脱垂等造口相关并发症的出现,是低位直肠癌保肛术中可供选择的预造口方式。     

延伸护理对直肠癌Miles术后造口患者生存质量的影响

目的探讨对直肠癌Miles术后造口患者开展延伸护理服务的效果。 方法将60例直肠癌Miles术后造口患者按随机数字表法分为对照组和试验组,每组30例。对照组采用门诊随访,传统应答措施;试验组采用护患沟通,录像播放,电话随访,互联网模式以及参加专题讲座形式开展延伸护理服务。比较2组患者的并发症发生率、规律性排便的建立、换袋技巧、自我护理能力、生活态度及性功能满意度。 结果试验组在并发症发生率、规律性排便的建立、自我护理能力和生活态度及性功能满意度方面均显著优于对照组,差异有统计学意义（P<0.05）。 结论对永久性结肠造口术后患者开展延伸护理服务有助于改善患者的生活质量。     

高分辨肛门直肠测压对直肠癌术后临时造口还纳的评估作用

目的评估高分辨肛门直肠测压检查能否客观反映直肠癌术后的肛门功能,能否成为临时造口还纳的依据。 方法选取2017年4月至2020年4月期间在中日友好医院普外科接受手术的170例直肠癌患者作为研究对象。将患者按照造口还纳后的前切除综合征评分分为无前切除综合征,轻度前切除综合征和重度前切除综合征3类。重度前切除综合征患者不适合造口还纳,据此将患者分为适合还纳组（141例）和不适合还纳组（29例）,适合还纳组包括无前切除综合征（75例）和轻度前切除综合征（66例）。患者均为临时性回肠造口,均在术后6个月时进行肛门直肠测压检查。肛门测压的各项结果在不同分组间进行Logistic回归分析。 结果有前切除综合征组患者的最大缩榨压明显更低（P=0.032,OR=1.033）,排便的最大耐受量也明显更小（P=0.011,OR=1.036）。不适合还纳组的静息压（P=0.002,OR=1.135）和最大缩榨压（P=0.001,OR=1.058）明显更低,排便感觉阈（P=0.049,OR=1.087）和最大耐受量（P=0.001,OR=1.059）也明显更小。 结论肛门直肠测压能够预测肛门功能的下降,可以作为临时造口是否应还纳的依据。     

直肠癌术后前切除综合征的研究进展

随着外科技术的提高和医学器械的改进,越来越多的低位直肠癌患者在得到肿瘤的根治性切除的同时得以保留肛门,避免了永久性造瘘。然而,较大比例的低位保肛患者,术后会出现一系列的肛门及肠道功能障碍,我们称之为前切除综合征。手术成功而治疗失败的临床案例屡见不鲜,前切综合征的出现严重影响了患者的生活质量,但其机制和诊疗措施尚缺乏统一的认知,本文将对前切除综合征这一临床症状的研究进展进行综述。     

国内结肠造口术和回肠袢式造口术对老年乙状结肠癌、直肠癌的临床疗效的Meta分析

目的应用Meta分析方法系统评价国内结肠造口术和回肠袢式造口术对老年乙状结肠癌、直肠癌的疗效及安全性。 方法计算机检索中国知网、万方数据知识服务平台、维普期刊资源整合服务平台、中国生物医学文献数据库,收集老年乙状结肠癌、直肠癌患者进行一期切除肿瘤并肠造口,二期对肠造口行闭合术的文献。检索时限均为从建库至2017年4月。制定纳入以及排除标准,查找相关文献,评价偏倚风险,最终提取纳入的文献的数据,使用RevMan 5.3软件进行Meta分析。 结果本项研究共有13篇文献,926例患者进行一期肿瘤切除并肠造口,二期对肠造口行闭合术入选,通过Meta分析结果显示,回肠袢式造口组一期术后排气时间（MD=-1.87,95%CI：-2.20~-1.54,P<0.001）、一期术后禁食时间（MD=-2.11,95%CI：-2.28~-1.94,P<0.001）、一期术后住院时间（MD=-0.53,95%CI：-0.97~-0.10,P=0.02）、一期术后并发症发生率（OR=0.55,95%CI：0.32~0.97,P=0.04）、二期手术时间（MD=-1.04,95%CI：-1.22~-0.86;P<0.001）、二期术后排气时间（MD=-1.67,95%CI：-1.89~-1.45;P<0.001）、二期术后禁食时间（MD=-1.67,95%CI：-1.90~-1.44;P<0.001）、二期术后住院时间（MD=-2.19,95%CI：-2.58~-1.79;P<0.001）、二期术后并发症发生率（OR=0.19,95%CI：0.11~0.33;P<0.001）与结肠造口组相比,差异有统计学意义,一期手术时间（MD=0.04,95%CI：-0.03~0.11;P=0.25）差异无统计学意义。 结论回肠袢式造口组在住院时间、肠胃功能恢复时间、二期手术时间、术后并发症发生率几个方面要优于结肠造口组。     

Effects of adjuvant radiotherapy on bowel function and anorectal physiology after low anterior resection for rectal cancer

We compared bowel function and anorectal physiology testing in rectal cancer patients who had undergone surgery alone, i.e. low anterior resection with colonic pouch (SA), to those also having preoperative radiotherapy (PREOP) or postoperative radiotherapy (POSTOP). The PREOP group were recruited from those who received 50.4 Gy (28 daily fractions over 5 1/2 weeks), and had their ileostomies closed for at least 1 year. Equivalent gender- and age-matched SA and POSTOP (50.4–54 Gy) patients who were operated upon during the similar time period were recruited. Bowel function questionnaire, anorectal manometry, anal electrosensation, pudendal nerve motor terminal latencies, barostat rectal sensation measurements and endoanal ultrasound were performed. There were 6 patients in each group. Bowel function questioning revealed that PREOP had significantly more incontinent episodes than SA patients (SA 2.9 ± 1.3, PREOP 10.3 ± 3.4, POSTOP 3.8 ± 0.6 episodes per week: p < 0.05; values expressed as mean ± SEM). The rectal volume of initial distension sensation on barostat ramp program testing was more impaired in the POSTOP than in PREOP group (SA 27.4 ± 5.3, PREOP 17.8 ± 4.3, POSTOP 37.5 ± 6.8 ml; p < 0.05). The left pudendal nerve motor terminal latency was more prolonged in the POSTOP than in the SA patients (SA 1.9 ± 0.2, PREOP 2.3 ± 0.1, POSTOP 4.3 ± 0.7 ms; p < 0.05). Patients who had preoperative radiotherapy had more incontinent episodes, and the rectal sensation may be more impaired after postoperative radiotherapy. Received: 30 December 1999 / Accepted: 17 January 2000     

The fate of the rectal stump after subtotal colectomy for ulcerative colitis

Objective To review the outcome of patients who had undergone subtotal colectomy for ulcerative colitis with formation of a rectal stump. To specifically look at the fate of the rectal stump, whether patients underwent emergency colectomy as opposed to urgent or elective resection. Patients and methods Between January 1990 and August 2000, a total of 31 patients underwent subtotal colectomy for ulcerative colitis. Patients were identified using the computerized coding system for the years 1995 to 2000, supplemented by pathology records, discharge letters, and operation notes. Postal and telephone surveys were undertaken using a standard questionnaire assessing social, physical, sexual, and bowel activities of patients. Results In 28 out of 31 patients, the follow-up was complete. Twenty-four of 28 patients (86%) underwent excision of rectal stump. Four patients (14%) preferred to undergo excision of rectum only, resulting in a permanent ileostomy; 20/28 (71%) had attempted ileal pouch–anal anastomosis, with success in 85%. In four patients (14%), the rectal stump remained in situ and was associated with a decrease in the quality of life. There were no perioperative deaths and morbidity was low for all procedures. Conclusion These data show that after subtotal colectomy, the majority of our ulcerative colitis patients undergo ileal pouch–anal anastomosis. Patients’ satisfaction is high with reasonable social and excellent sexual function on quality of life assessment. During its retention, the rectal stump causes considerable symptoms. When left in situ, it is associated with a decrease in the quality of life.     

Evaluation of selective defunctioning stoma after low anterior resection for rectal cancer

Background Anastomotic leakage is a major concern after resection for low rectal cancer. Therefore, the use of a defunctioning stoma (DS) has been suggested, but limited data exist to clearly determine the necessity of a routine diversion. In our department, the indication of DS was evaluated subjectively by the operating surgeon. The aim of this study was to evaluate the selective use of fecal diversion. Materials and methods Retrospective chart review of patients who underwent low anterior resection for carcinoma was performed. The incidence and consequences of clinical leaks were determined in these patients who were considered in two groups: defunctioning stoma and no defunctioning stoma. Results From 1995 to 2005, 132 consecutive patients underwent low anterior resection; a DS was performed in 42 patients (31.8%). Median level of anastomosis was 4 cm in both groups. Overall clinical leakage rate was 9.8%: 7.1% (n = 3) with a DS and 11% (n = 10) without a stoma. Mortality rate was 1.5% (n = 2), both in the unprotected group. No patient in the diversion group required a permanent stoma, contrasting with four unprotected patients in which continuity could not be restored after break down of the anastomosis. Conclusion Finding lower clinical leakage rate in a probable higher risk group and better outcome when a leak occurs in our study constituted strong evidence of the effectiveness of a DS. Selective use of a DS based on subjective assessment at the time of surgery could not allow experienced surgeons to perform single-stage procedure safely. Construction of a DS seems useful for patients with distal rectal cancer.