择期结直肠手术预防性应用抗生素的随机对照研究

目的探讨择期结直肠手术预防性应用抗生素的合理方案。方法将165例接受结直肠手术的患者随机分成3组：治疗1组（55例）在术前晚服用硫酸镁行肠道准备,麻醉诱导期静脉给予抗生素（头孢拉定2．0g）,术后追加应用2次抗生素（头孢拉定2．0g、0．5％甲硝唑100ml静脉滴注,24h内相隔12h应用）;治疗2组（50例）在治疗1组基础上,术后持续使用抗生素3～5d;对照组（60例）在治疗2组基础上,术前口服抗生素2～3d（甲硝唑0．4g,每日3次,卡那霉素0．2g,每日3次）。观察比较三组患者术后并发症（手术部位感染、吻合口漏、肠道菌群失调等）、术后白细胞变化、体温、住院时间和费用等指标。结果三组在术后手术部位感染、吻合口漏、术后白细胞计数及其下降幅度、术后体温、住院时间等方面差异均无统计学意义（P〉0．05）;治疗1组菌群失调发生率显著低于对照组（P〈0．05）;治疗1组平均抗生素使用费用显著低于另外两组（P〈0．05）。结论麻醉诱导期静脉给予抗生素,术后24h后停用抗生素是择期结直肠手术预防性应用抗生素的合理方案,可有效预防术后手术部位感染,抗生素相关不良反应少,并具有良好的经济效益。     

双吻合器法在直肠癌保肛手术中的应用

目的：探讨双吻合器吻合法在直肠癌保肛手术中的应用价值。方法：回顾性总结我院1994－1999年52例直肠癌应用双吻合器法行结直肠吻合保肛的经验。结果：本组52例，应用双吻合器的直肠癌手术中直肠残端闭合失败2例（3．8％），吻合器切割不全4例（7．6％），术后发生吻合口漏2例（3．8％），吻合口狭窄3例（5．8％），切口感染2例（3．8％），吻合口出血1例（1．9％）。术后局部复发3例（5．8％），无手术死亡。结论：双吻合器在低位直肠癌保肛手术中是安全可靠的，可以帮助外科医生完成以往手法缝合难以完成的低位结直肠吻合术。     

腹腔镜与开腹结直肠癌根治术后并发症发生率的比较

目的探讨腹腔镜与开腹结直肠癌根治术后并发症发生率的差异。方法对2000年1月至2011年9月同一组医师连续实施的910例腹腔镜结直肠癌根治术（腹腔镜组）和434例开腹结直肠癌根治术（开腹手术组）患者术后并发症发生情况的差异进行对比分析。结果腹腔镜组中转开腹48例（5．3％,48／910）,其中36例（75．0％,36／48）系因肥胖或骨盆狭窄致手术操作及显露困难。腹腔镜组和开腹手术组术后并发症总发生率分别为20．3％（185／910）和25．3％（110／434）（X^2=4．316,P〈0．05）;造口亚组中吻合口瘘的发生率分别为2．1％（3／145）和2．2％（2／93）（X^2=0．002,P〉0．05）,吻合1：3出血的发生率分别为3．4％（5／145）和4．3％（4／93）（X^2=0．113,P〉0．05）,未造口亚组中吻合口瘘的发生率分别为3．1％（22／699）和1．0％（3／301）（X^2=3．993,P〈0．05）,吻合口出血的发生率分别为1．6％（11／699）和2．3％（7／301）（X^2=0．673,P〉0．05）;肠梗阻的发生率分别为3．4％（31／910）和5．8％（25／434）（X^2=4．077,P〈0．05）;乳糜漏的发生率分别为5．8％（53／910）和3．7％（16／434）（X^2=2．757,P〉0．05,）;尿潴留的发生率分别为1．5％（14／910）和1．6％（7／434）（X^2=0．011,P〉0．05）;切口感染的发生率分别为2．2％（20／910）和4．6％（20／434）（X^2=5．913,P〈0．05）;肺部感染的发生率分别为6．4％（58／910）和10．6％（46／434）（X^2=7．349,P〈0．05）。结论腹腔镜结直肠癌根治术后总并发症的发生率显著低于开腹结直肠癌根治术,特别是前者术后肠梗阻、切VI感染与肺部感染发生率显著低于后者。     

新型肠内引流预防低位直肠吻合口瘘的临床研究

目的评价一种新型肠内引流技术预防低位直肠吻合口瘘的临床应用价值。方法将119例获得经腹切除、低位直肠吻合的直肠癌病例随机分成2组，研究组（55例）术中附加由生物可降解吻合环、避孕套复合而成的新型肠内引流装置；对照组（64例）术中附加回肠末端保护性造瘘：比较两组治疗结果。结果两组患者性别、年龄、体形、肿瘤位置、肿瘤大小、肿瘤分化、吻合位置、营养状态及伴随疾病等生理病理因素差异无统计学意义（P〉0．05）。无围手术期死亡者。全组病例3个月随访率100％。研究组吻合口瘘的发生率7．3％（4／55），内引流装置排出时间平均18．3d，无引流相关并发症，术后3个月仅见5．5％（3／55）无需松解治疗的吻合口轻度狭窄；吻合口瘘者漏后引流时间平均4．8d，前3日引流量平均12．8ml／d，无严重感染及保肛失败病例。对照组吻合口瘘发生率10．9％（7／64）；45．3％（29／64）的病例伴有肠造瘘相关并发症，3个月后有28．1％（18／64）的病例吻合口轻度狭窄，6．3％（4／64）的病例吻合口严重狭窄需进行松解治疗：吻合口瘘者漏后引流时间平均17．1d，前3日引流量平均35．4ml／d；2例并发严重感染，1例吻合口毁损而致保肛失败。两组吻合口瘘发生率的差异无统计学意义（P〉0．05），但漏后腹腔引流量、引流时间、感染及3个月后吻合口狭窄发生情况两组差异有统计学意义（P〈0．01）。结论新型肠内引流技术简便、安全．能有效避免低位直肠吻合口瘘所导致的严重后果。与预防性肠造瘘相比．保护吻合口的作用更为优越，同时也显著减少了因废用而导致的吻合口狭窄的发生率。     

胸腔镜单纯肺大疱切除围手术期不预防性应用抗生素的临床分析

目的探讨胸腔镜单纯肺大疱切除术围手术期不预防性应用抗生素的安全性、可行性。方法2011年6月～2012年8月114例择期胸腔镜单纯肺大疱切除术,其中67例围手术期不预防性应用抗生素（非抗生素组）,47例使用头孢硫脒标准预防（抗生素组）,比较2组患者术后切口愈合、感染的发生情况。结果2组患者均顺利完成手术,非抗生素组和抗生素组手术时间无统计学差异[（81．4±24．9）min vs．（78．6±24．9）min,t=0．591,P=0．556];术后2组患者均未发生切口感染,非抗生素组和抗生素组切口愈合不良发生率无明显差异[3．0％（2／67）vs．8．5％（4／47）,x^2=0．765,P=0．382];2组患者均未发生胸腔感染,肺部感染发生率无明显差异[4．5％（3／67）vs．4．2％（2／47）,x^2=0．000,P=1．000]。结论胸腔镜单纯肺大疱切除术围手术期不预防性应用抗生素并未增加术后感染率,是安全、可靠、可行的。     

选择性结直肠手术中机械性肠道准备的必要性

目的 分析机械性肠道准备在选择性结直肠外科手术中的必要性.方法 将77例行选择性结直肠手术的患者分为进行机械性肠道准备组(MBP组,42例)与未进行机械性肠道准备组(非MBP组,35例),分析两组术后吻合口瘘、感染等并发症发生的差异.结果 两组在术后吻合口瘘、切口感染、切口裂开等并发症发生方面无统计学差异(P＞0.05).结论 术前的MBP对降低选择性结直肠手术术后并发症方面没有显著的优势,术前MBP可能并非必要.     

腹股沟疝无张力修补术预防性应用抗生素与否的随机对照研究

目的：探讨腹股沟疝无张力修补术是否需预防性应用抗生素。方法选择我院2011年7月至2013年8月行腹股沟疝无张力修补术128例进行前瞻性随机对照研究。预防性应用抗生素组（对照组）64例术前30 min 单次给予抗生素注射,未使用抗生素组（观察组）64例术前未给予抗生素治疗,对比两组术后切口感染的发生率。结果切口感染对照组1例（1．56％）,观察组2例（3．12％）,组间比较差异无统计学意义（P ＞0．05）。结论常规应用抗生素对于无高危因素的腹股沟疝无张力修补术预防术后手术部位感染并无实质必要。     

腹腔镜与开腹结直肠癌根治术围手术期并发症发生率比较

目的 研究腹腔镜与开腹结直肠癌根治术围手术期并发症发生率的差异。方法 前瞻性、非随机对照2000年9月至2005年12月由同一组医师连续实施的214例腹腔镜结直肠癌根治术（腹腔镜手术组）与277例开腹结直肠癌根治术（开腹组）患者术中与术后2周内并发症发生率的差异。结果腹腔镜手术组中转开腹14例（6．5％）。术中腹腔镜手术组与开腹手术组并发症发生率分别为4．8％与3．6％（X^2=0．446，P〉0．05）。腹腔镜手术组出现骶前大出血、肠系膜下动脉根部出血、系膜出血、腹膜后气肿、吻合口破裂、直肠镜检并肠穿孔、阴道损伤及膈肌损伤各1例，直肠残端裂开2例；有7例予以中转开腹处理，术后无并发症出现。开腹手术组出现骶前大出血5例，直肠残端裂开与吻合口破裂各2例，输尿管损伤1例。术后腹腔镜手术组与开腹手术组并发症发生率分别为23．5％与36．8％（X^2=9．598，P〈0．01），其中并发肠梗阻分别为3．5％与6．5％（X^2=2．102，P〉0．05）；吻合口瘘分别为2．0％与3．0％（X^2=0．089，P〉0．05）；吻合口出血分别为5．8％与3．5％（X^2=1．064，P〉0．05）；乳糜瘘分别为1．5％与2．5％（X^2=0．201，P〉0．05）；肺部感染分别为7．0％与9．0％（X^2=0．635，P〉0．05）；切口感染分别为5．5％与14．1％（X^2=4．978，P〈0．05）。结论 腹腔镜结直肠癌根治术中并发症发生率与开腹手术无异，但术后并发症总发生率显著低于开腹手术。     

结直肠癌根治术中预防性末段回肠造瘘效果观察

目的观察结直肠癌Ⅰ期根治切除吻合术中,末段回肠造瘘预防高危吻合口漏的效果。方法对58例高吻合口漏风险的结直肠癌患者,行结直肠Ⅰ期根治切除吻合术,术中预防性末段回肠造瘘。回顾分析患者的诊疗资料。结果术后造瘘口处感染1例、手术切口感染2例、肠梗阻1例、吻合口漏1例、肺部感染1例、盆腔感染1例,均保守治疗治愈,无围手术期死亡患者。结论对高危吻合口漏的结直肠癌患者,Ⅰ期肿瘤根治性切除同时行预防性末端回肠袢式造瘘,可降低吻合口漏并发症的发生率。     

机械性肠道准备在择期结直肠手术中的应用：荟萃分析结果

目的系统评价机械性肠道准备（mechanical bowel preparation,MBP）在择期结直肠手术中的意义。方法采用Cochrane系统评价方法,检索1966～2012年Cochrane图书馆临床对照试验数据库、PubMed、Em．base、Cancerlit等数据库,2名评价员独立提取信息并评价文献质量后交叉比对,评价指标包括吻合口漏、总体手术部位感染（surgical site infection,SSI）、腹腔外感染及伤口感染发生率、再手术率和死亡率,采用RevMan5．1软件进行Meta分析。结果共有14篇文献进入Meta分析,累积样本含量5373例。与直接手术组相比,MBP组吻合121漏发生率[OR（95％C／）为1．08（O．82～1．43）,P=0．56]、总体SSI发生率[OR（95％C／）为1．26（O．94～1．68）。P=-0．12]、腹腔外感染发生率[OR（95％C1）为0．98（0．81～I．18）,P=0．81]、伤口感染发生率[0幔（95％C／）为1．21（1．00～1．46）,P=0．05]、再手术率[OR（95％CI为1．1l（0．86～1．45）,P=-0．42）及死亡率[OR（95％C／）为0．97（O．63～1．48）,P=0．88],差异均无统计学意义。结论没有证据支持在择期结直肠手术中使用MBP,MBP不应再作为临床常规使用。     

Randomized, multicenter trial of antibiotic prophylaxis in elective colorectal surgery: single dose vs 3 doses of a second-generation cephalosporin without metronidazole and oral antibiotics

HYPOTHESIS: Use of prophylactic antibiotics in elective colorectal surgery is essential. Although single-dose prophylactic antibiotics are recommended, the efficacy of single-dose cephalosporin without metronidazole and oral antibiotics is not fully proven. We conducted a multicenter, randomized trial of a single dose vs 3 doses of the second-generation cephalosporin cefmetazole. DESIGN: A prospective, randomized, multicenter trial in patients undergoing elective colorectal surgery. SETTING: Seven major hospitals in Japan that offer cancer treatment. PATIENTS: Patients with colorectal cancer treated from May 6, 2004, to April 25, 2005. INTERVENTIONS: Patients were randomized to 1 of 2 groups: a single-dose group given a single dose of cefmetazole just before skin incision and a 3-dose group given 2 additional doses of cefmetazole every 8 hours after the first dose just before skin incision. MAIN OUTCOME MEASURES: Incidences of incisional surgical site infection (SSI), organ or space SSI, and all other infectious complications within 30 days after surgery. RESULTS: A total of 384 patients were enrolled. Seven patients were excluded because of additional surgery or the inability to tolerate mechanical preparation. The incidence of incisional SSI was higher in the single-dose group (27/190 or 14.2%) than in the 3-dose group (8/187 or 4.3%) (P = .009). Incidences of organ or space SSI and other postoperative infectious diseases did not differ significantly between the 2 groups. In multivariate analysis, antibiotic dose was the only significant factor related to the incidence of incisional SSI. CONCLUSION: Three-dose cefmetazole administration is significantly more effective for prevention of incisional SSI than single-dose antibiotic administration. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00292708.     

Postoperative Prophylactic Antibiotics and Surgical Site Infection Rates in Breast Surgery Patients

Background  A single preoperative prophylactic dose of an intravenous antibiotic with antistaphylococcal activity is standard of care for breast and axillary surgical procedures. Some surgeons also prescribe postoperative prophylaxis for all patients with drains to prevent infection despite its lack of proven efficacy. Methods  A retrospective chart review of patients with breast and/or axillary surgical procedures between July 2004 and June 2006 were included. Data were collected on patient demographics, procedure types, and use of prophylactic antibiotics. Surgical site infection (SSI) was defined by means of Centers for Disease Control and Prevention criteria, including patients meeting the physician diagnosis criterion if an antibiotic was prescribed for a clinical diagnosis of cellulitis. χ² and Fisher’s exact tests were used to compare SSI rates. Results  Three hundred fifty-three patients with 436 surgical sites who received either preoperative or both pre- and postoperative antibiotic were analyzed. Overall, the SSI rate was 7.8% (34 of 436 surgical sites). Eighty-five patients (24%) with 127 surgical sites were provided both preoperative and postoperative prophylactic antibiotics. The SSI rates did not differ statistically (P = .67) for the groups that did (95% confidence interval, 4.8–15.0; 11 of 127 surgical sites, 8.7%) and did not receive postoperative antibiotic prophylaxis (95% confidence interval, 5.0–11.0; 23 of 309, 7.4%). Conclusions  Although the overall number of patients who developed SSI was relatively small, there was no reduction in the SSI rate among those who received postoperative antibiotic prophylaxis. Because of the potential adverse events associated with antibiotic use, further evaluation of this practice is required. Presented in part at the 62nd Annual Cancer Symposium of the Society of Surgical Oncology.     

Effect of body mass index and ertapenem versus cefotetan prophylaxis on surgical site infection in elective colorectal surgery

BACKGROUND: The effectiveness of prophylactic antibiotics in the prevention of surgical site infection (SSI) after elective colorectal surgery is dependent on many factors, including the body mass index (BMI) of the patient. In this study, the association of BMI and type of antibiotic prophylaxis with SSI was evaluated in patients undergoing elective colorectal surgery. METHOD: A post-hoc analysis was performed using data obtained from a multicenter randomized, double-blind study of 1,002 patients undergoing elective colorectal surgery who received prophylactic administration of ertapenem (1 g) or cefotetan (2 g). Among 650 evaluable patients, the effect of BMI and type of antibiotic prophylaxis on SSI rates was assessed four weeks after surgery. Mechanical bowel preparation was standardized, and no patient received oral antibiotics; intravenous antibiotics were not repeated during or after surgery. RESULTS: The majority of patients had a BMI between 18.5 and 39.9 kg/m2. Regardless of the type of prophylaxis, SSI rates were significantly higher in patients with a BMI > or = 30 kg/m2 than in those with a BMI < 30 kg/m2. However, failure, defined as SSI, was significantly less common after ertapenem than after cefotetan prophylaxis at both BMI < 30 kg/m2 (12.7% vs. 26.4%, respectively; difference -13.7; 95% confidence interval [CI] -21.0, -6.5) and BMI > or = 30 kg/m2 (26.7% vs. 41.9%, respectively; difference -15.3; 95% CI -28.2, -2.0). The most prevalent type of SSI was superficial incisional infection, which was more common with both treatments in patients with a BMI > or = 30 kg/m2; however, the incidence of superficial SSI was lower after ertapenem than cefotetan prophylaxis. CONCLUSION: In patients undergoing elective colorectal surgery, the incidence of SSI, specifically superficial incisional SSI, was higher in patients with a BMI > or = 30 kg/m2, regardless of the prophylactic antibiotic given. Ertapenem prophylaxis was more effective than cefotetan in the prevention of SSI at any BMI.     

890例全髋关节置换术围手术期抗生素使用情况的分析

目的回顾分析2003～2008全髋关节置换(THA)患者围手术期抗生素的使用情况,为防治THA术后感染以及预防性抗生素的临床应用提供借鉴。方法全部病例来源于广州市三间三等甲级医院。调查资料包括患者的基本情况、住院时间、疾病诊断、合并疾病、院内感染、转科情况、围手术期抗生素使用情况。对抗生素的种类、使用时间、是否联合用药等进行一般统计学描述。结果患者住院天数为(22.42±7.98)d,总费用为(43127.87±15178.59)元。全部病例中,关节置换术后近期低毒性感染2例,3例为迟发性深部感染,2例为浅部感染,2例为晚期深部感染,感染率为0.8%。2.7%的患者术前3天开始使用抗生素,6.97%术前1天开始静脉使用抗生素,98.65%患者手术前1小时内使用抗生素。术后全部患者静脉使用抗生素预防感染,17.64%患者采用静脉联合用药,1.12%的患者使用了两种以上的抗生素联合用药。25.84%患者第一种抗生素停用后静脉使用了第二种抗生素,还有5.28%患者静脉使用了三种抗生素,22.81%静脉后改口服,20.45%患者出院继续口服抗生素。患者静脉抗生素使用时间为(8.91±4.42)d,抗生素使用总时间为(12.65±9.83)d。结论根据患者的具体身体状况以及手术创伤情况,使用抗生素预防THA是一种得到骨科医师认可的有效方法。由于比较严重的抗生素滥用,建议完善THA围手术期抗生素应用指南,明确抗生素的选择指征及使用方法,而临床医师则应该严格遵守指南选择应用抗生素。     

An updated meta-analysis on the effectiveness of preoperative prophylactic antibiotics in patients undergoing breast surgical procedures

To systematically analyze published randomized trials on the effectiveness of preoperative prophylactic antibiotics in patients undergoing breast surgical procedures. Trials on the effectiveness of preoperative prophylactic antibiotics in patients undergoing breast surgery were selected and analyzed to generate summated data (expressed as risk ratio [RR]) by using RevMan 5.0. Nine randomized controlled trials encompassing 3720 patients undergoing breast surgery were retrieved from the electronic databases. The antibiotics group comprised a total of 1857 patients and non-antibiotics group, 1863 patients. There was no heterogeneity [χ(2) = 7.61, d.f. = 7, p < 0.37; I(2) = 8%] amongst trials. Therefore, in the fixed-effects model (RR, 0.64; 95% CI, 0.50-0.83; z = 3.48; p < 0.0005), the use of preoperative prophylactic antibiotics in patients undergoing breast surgical procedures was statistically significant in reducing the incidence of surgical site infection (SSI). Furthermore, in the fixed-effects model (RR, 1.30; 95% CI, 0.89-1.90; z = 1.37; p < 0.17), adverse reactions secondary to the use of prophylactic antibiotics was not statistically significant between the two groups. Preoperative prophylactic antibiotics significantly reduce the risk of SSI after breast surgical procedures. The risk of adverse reactions from prophylactic antibiotic administration is not significant in these patients. Therefore, preoperative prophylactic antibiotics in breast surgery patients may be routinely administered. Further research is required, however, on risk stratification for SSI, timing and duration of prophylaxis, and the need for prophylaxis in patients undergoing breast reconstruction versus no reconstruction.     

Use of Prophylactic Postoperative Antibiotics During Surgical Drain Presence Following Mastectomy

Background

National guidelines recommend one dose of perioperative antibiotics for breast surgery and discourage postoperative continuation. However, reported skin and soft tissue infection (SSI) rates after mastectomy range from 1–26 %, higher than expected for clean cases. Utility of routine or selective postoperative antibiotic use for duration of drain presence following mastectomy remains uncertain.

Methods

This study included all female patients who underwent mastectomy without reconstruction at our institution between 2005 and 2012. SSI was defined using CDC criteria or clinical diagnosis of cellulitis. Information on risk factors for infection (age, body mass index [BMI], smoking status, diabetes, steroid use), prior breast cancer treatment, drain duration, and antibiotic use was abstracted from medical records. Multivariable logistic regression was used to assess the association between postoperative antibiotic use and the occurrence of SSI, adjusting for concurrent risk factors.

Results

Among 480 patients undergoing mastectomy without reconstruction, 425 had sufficient documentation for analysis. Of these, 268 were prescribed antibiotics (63 %) at hospital discharge. An overall SSI rate of 7.3 % was observed, with 14 % of patients without postoperative antibiotics developing SSI compared with 3.4 % with antibiotics (p < 0.0001). Factors independently associated with SSI were smoking and advancing age. Diabetes, steroid use, BMI, prior breast surgery, neoadjuvant chemotherapy, prior radiation, concomitant axillary surgery, and drain duration were not associated with increased SSI rates.

Conclusions

SSI rates among patients who did and did not receive postoperative antibiotics after mastectomy were significantly different, particularly among smokers and women of advanced age. These patient subgroups may warrant special consideration for postoperative antibiotics.     

Prophylactic antibiotics in aesthetic surgery

Improvements in infection prevention practices over the past several decades have enhanced outcomes following aesthetic surgery. However, surgical site infections (SSI) continue to result in increased morbidity, mortality, and cost of care. The true incidence rate of SSI in aesthetic surgery is unknown due to the lack of a national surveillance system, but studies of SSI across surgical specialties have suggested that many of these infections are preventable. Patient-related factors-including obesity, glycemic control, and tobacco use-may contribute to the development of SSI following aesthetic surgery. In terms of SSI prevention, proper handwashing and surgical skin preparation are integral. Furthermore, the administration of prophylactic antibiotics has been shown to reduce SSI following many types of surgical procedures. Unfortunately, there are few large, randomized studies examining the role of prophylactic antibiotics in aesthetic surgery. The authors review the medical literature, discuss the risks of antibiotic overutilization, and detail nonpharmacological methods for reducing the risk of SSI.     

Ⅰ类切口手术围手术期规范使用抗菌药物的临床效果观察

目的观察Ⅰ类切口手术（以甲状腺手术、疝气手术、乳腺手术为主）围手术期规范使用抗菌药物的临床优势。方法采用前瞻性研究与回顾性调查相结合对照的方法,填写Ⅰ类切口手术病例调查登记表,然后进行数据收集汇总及整理分析。结果对照组与试验组的围手术期预防用药使用率分别为100.0%、27.5%（P〈0.05）,手术部位切口感染率分别为2.5%、0.8%（P〉0.05）;试验组患者的术后预防用药天数和住院天数均略短于对照组（P〈0.05）,抗菌药物费用少于对照组（P〈0.05）。结论Ⅰ类切口手术围手术期规范使用抗菌药物大大降低了预防用药的使用率,缩短了术后用药天数,同时在缩短患者住院天数,减轻其经济负担等方面有明显的优势,而且不会增加手术部位切口感染的机会。规范用药观念的推广使临床医生提高了合理使用抗菌药物的意识,对感染管理部门在预防与控制手术部位切口感染方面提出了更高的要求。     

预防性造口在低位直肠癌手术中的应用分析

目的探讨预防性造口在低位直肠癌手术中的应用价值。方法采用病例对照研究,将湖南省攸县人民医院普外科2011年1月~2013年4月期间共46例低位直肠癌患者分为两组:26例行预防性回肠造口(A组),其中23例为回肠双腔造口,3例为回肠单腔造口,术后3月回纳造口;20例未行预防性造口(B组)。对比其术后吻合口漏、肠梗阻、切口感染等并发症发生率。结果 46例患者中共发生7例吻合口漏,其中A组2例(7.7%),B组5例(25%),且死亡1例,两组比较无显著性差异(P0.05);切口感染率A组6例(23.1%),B组5例(25%),两组比较无明显差异(P0.05);肠梗阻发生率A组1例(3.8%),B组3例(15%),两组比较无显著性差异(P0.05)。结论预防性造口可有效降低低位直肠癌术后吻合口漏发生率。对存在2个以上危险因素,尤其是超低位直肠癌(距肛缘低于5cm)推荐行预防性造口术。