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目的探讨应用回肠蕈状双腔造口预防腹腔镜直肠癌全直肠系膜切除(TME)术后吻合口漏的可行性。方法回顾性分析2006年4月至2010年3月辽宁省肿瘤医院大肠外科应用回肠蕈状双腔造口术预防腹腔镜TME术后吻合口漏的65例(造口组)及同期未行预防性造口的腹腔镜直肠癌TME手术85例(未造口组)病人临床资料。腹腔镜下完成低位或超低位吻合后,造口组于距回盲瓣30～40cm处回肠于右髂前上棘与脐连线外1/3处行双腔造口,回肠沿与纵轴垂直方向切开达1/2周,近端做蕈状乳头高于皮肤0.5cm,远端回肠平坦式缝合于皮肤。骶前放置双腔引流管。术后3～5个月闭瘘。未造口组仅骶前放置双腔引流管。结果造口组病人粪便转流彻底。无造口周围皮肤严重腐蚀与不耐受,无死亡病例,无吻合口漏。未造口组5例出现吻合口漏,3例4～8周后愈合,2例行手术造口治疗后治愈,无死亡病例。结论应用回肠蕈状双腔造口术预防腹腔镜直肠癌TME术后吻合口漏是可行的,造口护理方便,闭瘘创伤小,粪便转流彻底。

Application of preventive ileum fungating double-cavity fistulation in preventing anastomotic leakage after laparoscopic TME of rectal cancer

Objective To study the feasibilitiy of preventive ileum fungating double-cavity fistulation in preventing anastomotic leakage after laparoscopic TME of rectal cancer.Methods The clinical data of 65 cases of preventive ileum fungating double-cavity fistulation after laproscopic TME and 85 cases not performed fistulation in the same period between April 2006 and March 2010 in Department of Large-intestine Surgery,Liaoning Province Cancer Hospital were analyzed retrospectively.For fistulation group,the surgical method was as following:after finished lower/ultra lower anastomosis,made ileum fungating double-cavity fistulation with the ileum 30-40 cm to ileocecus on the place of the external 1/3 line from umbilicus to the right anterior superior spine in fistulation group;made vertical incision of 1/2 circle of ileum along with the vertical axis,and made fungi nipple higher than 0.5 cm of skin on proximal ileum,and sutured distal ileum to skin flat;put dual-drainage tube to the anterior sacrum for 3-5 months after operation,then closed the fistula.For non-fistulation group,dual-drainage tube was put to the anterior sacrum only.Results In fistulation group,feces diverted thoroughly;all the cases had no skin serious corrosion and intolerance surrounding fistula;neither deaths nor anastomotic leakage occurred.In non-fistulation group,5 cases appeared anastomotic leakage.Among them,3 cases healed after 4 to 8 weeks and 2 cases were performed colostomy.No death occurred.Conclusion The application of preventive ileum fungating double-cavity fistulation in preventing anastomotic leakage after laparoscopic TME of rectal cancer is feasible with convenient ostomy care,small trauma of closing fistula and thorough feces diversion.