Hartmann术及回肠袢式造口术治疗老年梗阻性肠癌的疗效分析

目的:分析结肠造口术(Hartmann术)及回肠袢式造口术治疗老年梗阻性乙状结肠癌和高位直肠癌的临床效果。方法:回顾性分析经术后病理确诊为梗阻性乙状结肠癌和高位直肠癌患者137例,其中61例患者采用Hartmann术(Hartmann组),66例患者采用回肠袢式造口术(回肠袢式造口组)。对比分析两组患者一、二期手术的围手术期指标和手术并发症差异。结果:Hartmann组与回肠袢式造口组的手术时间、住院时间差异无统计学意义(P0.05);回肠袢式造口组的肛门排气时间、禁食时间显著的短于Hartmann组(P0.05)。一期手术时,Hartmann组和回肠袢式造口组的并发症率分别为6.56%、7.58%,组间无统计学差异(P0.05);二期手术时,回肠袢式造口组的手术时间、肛门排气时间、禁食时间、住院时间显著的短于Hartmann组(P0.05);二期手术时,回肠袢式造口组并发症率为6.06%明显低于Hartmann组的18.03%(P0.05);回肠袢式造口组和Hartmann组的WHOQOL-BREF总分、生理、心理、社会关系及环境四个领域评分差异均无统计学意义(均P0.05)。结论:Hartmann手术与回肠袢式造口手术的效果相当,但相对术后恢复时间较长,II期手术后并发症率较高。     

回肠袢式造口和结肠造口在梗阻性左半结肠癌根治性手术中的疗效对比研究

目的探讨回肠袢式造口和结肠造口在梗阻性左半结肠癌根治性手术中的应用价值。方法纳入70例梗阻性左半结肠癌患者作为研究对象,所有患者均接受根治性手术,随机分为两组,每组各35例。观察组行回肠袢式造口,对照组行结肠造口术。比较两组手术基本情况、术后并发症及术后2年生存率。结果观察组Ⅰ期、Ⅱ期术后排气时间和禁食时间均显著短于对照组(均P0.05),观察组Ⅱ期手术时间和住院时间均短于对照组(均P0.05)。两组Ⅰ期术后并发症总发生率差异无统计学意义(P0.05),观察组Ⅱ期术后并发症总发生率低于对照组(P0.05)。两组患者术后患者2年生存率差异无统计学意义(P0.05)。结论与结肠造口相比,回肠袢式造口用于梗阻性左半结肠癌可减少Ⅱ期手术的并发症,更有利于促进术后恢复。     

两种袢式肠造口术并发症发生情况的比较

目的 比较传统肠袢式造口术和改良肠袢式造口术的并发症发生情况.方法 对2000年9月到2011年9月本院进行的29例传统肠袢式造口术(传统组)和33例改良袢式造口术(改良组)并发症发生情况进行比较.结果 改良组在造口旁皮炎、造口粪便转流不全方面明显低于传统组(P＜0.05).结论 改良袢式造口术术后与造口有关的并发症发生率低,易于患者术后对肠造口的管理,且该手术操作较为简单,值得临床推广应用.     

腹腔镜全膀胱切除术后三种不可控尿流改道并发症的探讨

目的:探讨腹腔镜全膀胱切除术后三种不可控尿流改道手术期间、早期及晚期并发症情况。方法:回顾分析2008年12月至2012年7月为82例浸润性膀胱癌患者行腹腔镜全膀胱切除术的临床资料,其中男59例,女23例,平均(62.4±5.3)岁。34例行回肠膀胱术,21例行结肠膀胱术,27例行输尿管皮肤造口术。结果:回肠膀胱术患者术后平均住院(14.0±2.1)d,结肠膀胱术平均(15.8±1.9)d,输尿管皮肤造口术平均(13.6±1.8)d。平均随访(22.4±6.7)个月,回肠膀胱术组手术期间并发症发生率明显高于其他两组(P0.05),早期并发症3组间差异无统计学意义(P0.05),晚期并发症回肠膀胱术组显著高于其他两组(P0.05)。结论:腹腔镜全膀胱切除术适于高风险的患者,且并发症与尿流改道术方法选择密切相关。相较结肠膀胱术、输尿管皮肤造口术,回肠膀胱术的手术期间、晚期并发症发生率最高,而早期并发症3组差异无统计学意义。     

自闭性保护性回肠造口与传统袢式回肠造口在高危结直肠吻合口患者中的应用效果观察

目的比较自闭性保护性回肠造口与传统袢式回肠造口在高危结直肠吻合口患者中的临床应用价值。方法回顾性分析2014年7月至2017年12月广西桂东人民医院普外科收治的需行保护性造口的59例高危结直肠吻合手术患者临床资料,根据造口方法不同分成观察组及对照组,观察组行自闭性保护性回肠造口术(n=36),对照组行传统袢式回肠造口术(n=23)。比较两组患者肠道再通时间、总住院时间、住院费用以及并发症发生情况。结果观察组钉闭肠腔的回肠均能自行开放。观察组肠再通时间及总住院时间短于对照组,住院费用少于对照组,差异均有统计学意义(均P0.05)。两组术后并发症总发生率差异无统计学意义(P0.05)。结论自闭性保护性回肠造口与传统袢式回肠造口保护高危结直肠吻合口均收效良好,前者操作更为简单且避免了二期造口还纳手术,更有助于缩短肠再通时间及总住院时间,也有利于减少患者住院费用。     

克罗恩病肠造口术

正肠造口术始于18世纪,1776年Pillore因治疗直肠癌导致的肠梗阻创建了第1例袢式结肠造口,随后相继出现了端式结肠造口、双腔结肠造口等多种术式。1879年Baum完成了第1例回肠造口术,但因其并发症发生率高,使用受限。1953年Brooke提出"黏膜外翻缝合"的造口技术,亦即"玫瑰花蕾"的造口方法,大大降低了回肠造口的并发症发生率。此后,造口手术日趋成熟,成为胃肠外科最常见的     

预防性应用防粘连补片对结肠造口术后造口旁疝发生率的影响

目的探讨预防性应用防粘连补片对结肠造口术后造口旁疝发生率的影响。方法选取2014年12月至2015年3月,潮州市中心医院行腹腔镜下腹会阴联合切除加末端结肠造口术的直肠癌82例患者临床资料,随机分为处理组与对照组,每组患者41例。对照组患者接受传统末端结肠造口术,处理组患者在传统末端结肠造口术的基础上加用防粘连补片固定于造口周围。评价并记录患者术后12个月内造口旁疝发生情况和分型,造口相关并发症,造口周围疼痛程度和造口孔洞面积。结果在术后12个月内,处理组的Ⅰ型与Ⅲ型造口旁疝发生率较对照组降低,差异有统计学意义(P0.05),而2组Ⅱ型与Ⅳ型造口旁疝发生率比较,差异无统计学意义(P0.05);处理组与对照组造口相关并发症:出血、脱垂、狭窄、回缩和造口周围皮肤炎症的发生率比较,差异无统计学意义(P0.05);2组术后第1、12个月的造口周围疼痛VAS评分比较,差异无统计学意义(P0.05);处理组与对照组术后第1个月造口孔面积比较,差异无统计学意义(P0.05),而在术后第12个月对照组患者造口孔面积显著大于处理组(P0.05)。结论回结肠末端造口术中应用防粘连补片可以降低术后早期造口旁疝的发生率,且不增加其他造口相关的并发症,是一种安全有效的预防造口旁疝的方法,值得进一步推广和研究。     

袢式回肠造口与自闭性保护性回肠造口在高危结直肠吻合术中的应用比较

目的观察高危直肠吻合术中应用自闭性保护性回肠造口的临床效果。方法 86例高危结直肠吻合术患者,随机分为对照组与观察组,每组43例。对照组接受袢式回肠造口手术,观察组接受自闭性保护性回肠造口术。比较两组手术指标、术后指标、并发症发生情况。结果两组住院时间比较,观察组短于对照组(P0.05)。两组术后指标比较,首次肛门排气时间、肛门恢复排便时间、肠再通时间观察组均早于对照组(P0.05)。两组术后肠梗阻、切口感染、肠造瘘口回缩、肠造瘘口坏死等并发症发生率差异无显著性(P0.05)。结论自闭性保护性回肠造口术住院时间短,患者胃肠道功能恢复更快。     

结直肠癌患者肠造口术后辅助化疗对造口并发症的影响

目的:探讨结直肠癌患者肠造口术后辅助化疗对造口并发症的影响。方法:选择2017年1月至2022年6月我院收治的60例结直肠癌肠造口术后辅助化疗者(观察组)以及同期60例术后未行辅助化疗者(对照组),比较2组患者术后7d及3个月造口周围皮肤状况、造口功能情况。结果:2组术后7 d结肠造口、回肠单腔造口、回肠双腔造口周围皮肤状况评分及造口功能评分比较差异均无统计学意义(P>0.05)。术后3个月，2组除结肠造口周围皮肤状况评分无明显变化(P>0.05)外，回肠单腔造口、回肠双腔造口周围皮肤健康状况评分及结肠造口、回肠单腔造口、回肠双腔造口功能评分均明显升高(P<0.05),且观察组评分均高于对照组(P<0.05)。结论:结直肠癌患者肠造口术后辅助化疗对造口会产生一定负面影响，如造口功能下降、造口皮肤并发症增多等。     

完全腹腔镜根治性右半结肠切除术在老年结肠癌患者应用中的前瞻性研究

目的探讨老年结肠癌患者行完全腹腔镜根治性右半结肠切除术的安全性、可行性。方法前瞻性选择2017年2月～2018年11月我院收治的80例老年右半结肠癌患者,按照随机数字表法分成两组,观察组患者采用完全腹腔镜根治性右半结肠切除术,对照组患者采用腹腔镜辅助根治性右半结肠切除术。比较两组患者的基线情况、术前ASA分级、术前肿瘤分期(TNM)、手术指标、术后指标、术后并发症等。结果两组患者间年龄、性别、体质指数、术前合并症、ASA分级、TNM分期,差异均无统计学意义(P0.05)。两组患者间手术时间、术中出血量、术后淋巴结数、标本长度、住院时间,差异均无统计学意义(P0.05)。观察组、对照组术后切口长度分别为(4.2±0.8 vs 5.9±0.7)cm,差异有明显统计学意义(P0.00)。观察组术后肠功能恢复时间、首次流质饮食时间均早于对照组(2.5±1.4 vs 3.2±1.3)d、(2.6±1.4 vs 3.2±1.4)d,差异均有统计学意义(P0.05)。观察组、对照组术后并发症的发生率分别为(12.5%vs 15.0%),差异无统计学意义(P0.05)。结论老年结肠癌患者行完全腹腔镜根治性右半结肠切除术是安全、可行的,并可获得更好的术后恢复。     

Loop Ileostomy versus Loop Colostomy for Defunctioning Low Anastomoses during Rectal Cancer Surgery

Several studies have compared loop ileostomy with loop colostomy to defunction colorectal anastomoses. The discordant results may be due to the heterogeneity of the indications. We therefore performed a retrospective study to compare the two procedures in a homogeneous group of patients operated on electively for rectal cancer. Among 462 consecutive patients undergoing rectal resection for cancer during 1986–1998, 60 had a loop colostomy and 107 a loop ileostomy to defunction a low anastomosis. The two groups were similar with respect to age, gender, obesity, tumor stage, and duration before closure (109 vs. 104 days; p= 0.28). All the stoma-related complications that occurred after construction and after closure of the stoma were recorded. There were no stoma-related deaths in the two groups. After stoma construction, the morbidity rate was significantly higher following loop colostomy than after loop ileostomy (35% vs. 19%; p= 0.02). After stoma closure the complication rate was significantly higher in the colostomy group than in the ileostomy group (34% vs. 12%; p= 0.004). The risk of surgical reintervention related to the morbidity of both construction and closure of the stoma was twice as high after loop colostomy than after loop ileostomy (22% vs. 9%; p= 0.03). The results of this study showed that, in our experience, the overall stoma-related morbidity and risk of reoperation were significantly lower after loop ileostomy than after loop colostomy. This suggests that loop ileostomy is the best procedure for defunctioning colorectal anastomoses electively. We therefore recommend using a loop ileostomy during rectal cancer surgery.     

老年结直肠癌患者腹腔镜手术的安全性研究

目的 探讨腹腔镜治疗老年结直肠癌患者的安全性和可行性.方法 回顾性分析2005年1月至2008年12月北京大学人民医院收治的117例老年结直肠癌患者(年龄≥70岁)的临床资料.根据手术方式不同将其分为腹腔镜组(49例)和开腹组(68例),并对两组术后恢复情况、并发症、随访结果进行比较.两组数据比较采用t检验、X~2检验和Mann-Whitney U检验,并采用Kaplan-Meier和Log-rank检验分析患者生存情况.结果 腹腔镜组平均手术时间为(246±64)min,显著长于开腹组的(218±50)min(t=-2.677,P<0.05).腹腔镜组术中出血量、平均肛门排气时间、术后平均住院时间、术后镇痛剂使用比例和并发症发生率分别为(207±135)ml、3 d、12 d、45%(22/49)和20%(10/49),显著优于开腹组的(296±178)ml、4 d、14 d、74%(50/68)和44%(30/68)(t=2.920,U=770.5、1181.0,X~2=9.864、7.115,P<0.05).腹腔镜组肠管切除长度和淋巴结清扫数目分别为(19±7)cm和(13±6)枚,开腹组为(20±8)cm和(16±6)枚,两组比较差异无统计学意义(X~2=0.790,t=2.007,P>0.05).腹腔镜组和开腹组术后1年累积生存率分别为95.4%和94.7%,3年累积生存率分别为85.2%和82.3%,两组比较差异无统计学意义(X~2=0.581,P>0.05).结论 老年结直肠癌患者行腹腔镜切除手术安全可行.     

预防性横结肠造瘘与末端回肠造瘘在直肠癌低位前切除术中应用比较

目的:比较预防性横结肠造瘘与末端回肠造瘘应用于直肠癌低位前切除术的临床效果。方法:回顾分析79例低位直肠癌行保肛并预防性肠造瘘手术患者临床资料,其中预防性横结肠造瘘33例,预防性末端回肠造瘘46例。比较两组患者术后吻合口瘘、造瘘口相关并发症发生情况以及血清炎症因子水平。结果:两组患者术前资料具有可比性。横结肠造瘘组发生吻合口瘘2例(6.06%),末端回肠造瘘组4例(8.70%),两组间差异无统计学意义(P0.05);横结肠造瘘组切口感染发生率高于末端回肠造瘘组(P0.05),其他造瘘口相关并发症发生率两组间差异无统计学意义(均P0.05);与术前两组血清C-RP及IL-6水平比较,差异无统计学意义(均P0.05);横结肠造瘘组术后24、48、72 h血清C-RP及IL-6水平均明显高于末端回肠造瘘组(均P0.05)。结论:低位直肠癌前切术中,采用预防性横结肠造瘘与预防性末端回肠造瘘在防止吻合口瘘方面效果相似,但末端回肠造瘘术在减轻术后创伤应激反应,减少并发症方面优于横结肠造瘘术。     

腹腔镜低位和超低位直肠癌保肛根治术中改良襻式回肠末端造瘘的应用价值

目的 探讨腹腔镜低位和超低位直肠癌保肛根治术中预防性使用改良襻式回肠末端造瘘的临床应用价值。方法 回顾性分析2010年1月至2012年6月江苏省苏北人民医院收治的108例直肠癌患者的临床资料。所有患者采用腹腔镜低位或超低位直肠癌保肛根治术,其中53例采用预防性改良襻式回肠末端造瘘（预造瘘组）,55例未采用预防性改良襻式回肠末端造瘘（未造瘘组）。对两组患者术中和术后情况进行比较研究。计量资料采用用x±s表示,组间比较采用t检验;计数资料采用率或构成比表示,组间比较采用X2检验或Fisher确切概率法。结果预造瘘组和未造瘘组患者手术时间分别为（185±14）min和（154±12）min,术中出血量分别为（31±26）ml和（28±19）ml,两组比较,差异无统计学意义（t=2.34,1.82,P〉0.05）;术后肛门排气时间分别为 （1.1±0.3）d和（4.2±0.6）d,术后进食时间分别为（1.1±0.2）d和（4.3±0.6）d,盆腔引流管拔出时间分别为（5.2±1.0）d和（8.4±3.9）d,两组比较,差异有统计学意义（t=7.25,28.12,15.34,P〈0.05）;并发症发生率分别为5.7%（3/53）和21.8%（12/55）,吻合口瘘发生率分别为0和12.7%（7/55）,两组比较,差异有统计学意义（P〈0.05）;术后住院时间分别为（7.2±1.4）d和（12.9±4.4）d,治疗费用分别为（3.0±0.2）万元和（3.8±0.7）万元,两组比较,差异有统计学意义（t=34.01,7.83,P〈0.05）。结论 对腹腔镜低位和超低位直肠癌保肛根治术患者施行预防性改良襻式回肠末端造瘘,能有效降低吻合口瘘的发生,有利于患者快速康复。     

Comparison of Outcomes Following Ileostomy versus Colostomy for Defunctioning Colorectal Anastomoses

Background The present study evaluated outcomes of patients undergoing proximal diversion using either a loop ileostomy or loop colostomy following distal colorectal resection for malignant and non-malignant disease. Methods A literature search of the Medline, Ovid, Embase and Cochrane databases was performed to identify studies published between 1966 and 2006, comparing loop ileostomy and loop colostomy to protect a distal colorectal anastomosis. A random effect meta-analytical technique was used and sensitivity analysis performed on studies published since 2000, higher quality papers, those reporting on 70 or more patients, and those reporting outcomes following colorectal cancer resections. Results Seven studies, including three randomised controlled trials, satisfied the inclusion criteria. Outcomes of a total of 1,204 patients were analysed, of whom 719 (59.7%) underwent defunctioning loop ileostomy. High stoma output was more common following ileostomy formation (OR = 5.39, 95% CI: 1.11, 26.12, P = 0.04), but wound infections following their reversal were significantly fewer (OR = 0.21, 95% CI: 0.07, 0.62, P = 0.004). Overall complications were less frequent for ileostomy patients in the subgroup of high quality studies (OR = 0.22, 95% CI: 0.08, 0.59, P = 0.003). Conclusion The results of this meta-analysis suggest that ileostomy may be preferable to colostomy when used to defunction a distal colorectal anastomosis. Wound infections following stoma reversal were reduced, as were overall stoma-related complications and incisional hernia following stoma reversal for ileostomy patients in high quality studies.     

低位直肠癌保肛中预防性造口的临床应用分析

目的探讨预防性造口在低位直肠癌保肛术中的临床应用价值。方法分析2010年3月至2013年10月期间收治的37例低位直肠癌保肛术患者的临床资料,两组患者术前均经病理检查确诊,癌灶下缘距肛缘小于7 cm。将患者分成预防性造口组(19例)、未施行预防性造口组(18例),应用SPSS17.0对相关数据进行处理。手术时间、术中出血、首次排气排便时间、首次进食时间、住院时间等计量资料比较用t检验;术后并发症、再手术率发生率等资料用χ~2检验,P0.05差异具有统计学意义。结果预防性造口组术后首次排气、排便时间为(2.8±0.6)d,未施行预防性造口组为(4.1±0.5)d,差异有统计学意义(t=1.92,P0.05);术后首次进食时间分别为(3.8±1.2)和(5.6±1.8)d;术后平均住院时间分别为(8±2)d和(12±2)d,差异均有统计学意义(t=2.34,t=2.68,P0.05)。术后总并发症预防性造口组为1/19(5.3%),未施行预防性造口组为4/18(22.2%),两组术后总的并发症发生率差异有统计学意义(χ~2=4.75,P0.05)。预防性造口组发生1例(5.3%)吻合口漏,经反复腹腔冲洗引流等保守治疗后痊愈;未造口组发生3例(16.7%)吻合口漏,其中2例经保守治疗后愈合,1例发展为弥漫性腹膜炎接受再手术;经检验,两组吻合口漏发生率有显著统计学差异。两组术后均无因吻合口漏而死亡的病例。结论预防性造口能显著降低吻合口漏的发生率,同时也能降低与吻合口吻合口漏相关的再手术率。对吻合口高度较低及具有高危因素的患者,建议常规施行预防性造口。     

Colostomy or ileostomy after colorectal anastomosis?: a randomised trial.

Sixty one patients were entered in a randomised trial to compare transverse loop colostomy with loop ileostomy after a colorectal anastomosis thought to be at risk of dehiscence. Radiologically proven breakdown of the colorectal anastomosis occurred in 13% of these selected patients and most frequently in the colostomy group. Ileostomies functioned earlier than colostomies (P less than 0.001) but there was no other significant difference in outcome between the groups. In 52 patients intestinal continuity was restored by excision of the stoma within a month of construction with no difference in morbidity between the two groups. A loop ileostomy, closed as soon as the colorectal anastomosis has healed, is recommended as an alternative to transverse colostomy.     

De-functioning stomas: a prospective controlled trial comparing loop ileostomy with loop transverse colostomy

Patients undergoing colorectal surgery who required a defunctioning stoma were randomly allocated to receive either a loop ileostomy (n = 23) or transverse loop colostomy (n = 24). Assessment was made during construction, immediately postoperatively, during the period of outpatient supervision and before and after stoma closure. The ileostomy was associated with significantly less odour than the colostomy (P less than 0.01) and required significantly less appliance changes (P less than 0.05). Furthermore eleven patients (58 per cent) with a colostomy experienced three or more problems with stoma management compared with only three patients (18 per cent) with an ileostomy (P less than 0.05). Wound infection was also significantly more common after closure of the colostomy compared with the ileostomy. Both types of stoma were demonstrated objectively to defunction the distal bowel almost completely. These results indicate that a loop ileostomy is the procedure of first choice when a stoma is needed to defunction the distal colorectum.     

结肠襻式和回肠襻式造口并发症发生风险的Meta分析

目的 评价结肠襻式造口和回肠襻式造口的并发症发生风险.方法 检索Medline、Embase、Cochrane Library、Google Scholar及万方数据库公开发表的比较结肠襻式造口和回肠襻式造口并发症发生风险的论文;检索文献发表时间至2011年4月15日.通过Meta分析,定量评价两者的并发症发生率,采用Z检验分析数据,采用Q检验检测异质性.结果 本研究一共纳入5篇随机对照研究和8篇非随机对照研究,共有1752例研究对象.与回肠襻式造口术比较,结肠襻式造口发生造口脱垂的风险较大,差异有统计学意义(OR =3.46,95％CI为1.81～6.63,P＜0.05);两种造口术后发生造口出血、狭窄、切口感染、造口坏死、造口周围皮炎、造口旁疝等并发症风险比较,差异无统计学意义.与回肠襻式造口回纳术比较,结肠襻式造口回纳术后发生切口感染的风险较大,差异有统计学意义(OR =3.44,95％CI为1.95～6.05,P＜0.05);回肠襻式造口回纳术后肠梗阻的发生风险较大,差异有统计学意义(OR=0.43,95％ CI为0.20～0.91,P＜0.05);两种造口回纳术后发生肠液漏风险比较,差异无统计学意义(P＞0.05).结论 结肠襻式造口术后发生造口脱垂及回纳术后切口感染的风险较大,而回肠攀式造口回纳术后肠梗阻发生的风险较大.     

Randomized clinical trial comparing loop ileostomy and loop transverse colostomy for faecal diversion following total mesorectal excision

BACKGROUND: The aim of this study was to compare loop ileostomy and loop transverse colostomy as the preferred mode of faecal diversion following low anterior resection with total mesorectal excision for rectal cancer. METHODS: Patients who required proximal diversion after low anterior resection with total mesorectal excision were randomized to have either a loop ileostomy or a loop transverse colostomy. Postoperative morbidity, stoma-related problems and morbidity following closure were compared. RESULTS: From April 1999 to November 2000, 42 patients had a loop ileostomy and 38 had a loop transverse colostomy constructed following low anterior resection. Postoperative intestinal obstruction and prolonged ileus occurred more commonly in patients with an ileostomy (P = 0.037). There was no difference in time to resumption of diet, length of hospital stay following stoma closure and incidence of stoma-related complications after discharge from hospital. A total of seven patients had intestinal obstruction from the time of stoma creation to stoma closure (six following ileostomy and one following colostomy; P = 0.01). CONCLUSION: Intestinal obstruction and ileus are more common after loop ileostomy than loop colostomy. Loop transverse colostomy should be recommended as the preferred method of proximal faecal diversion.