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。

A comparative study of ileal loop-type ileostomy and modified terminal ileum cannula ileostomy in anus preservation operation on low rectal cancer

ObjectiveRetrospective analysis of clinical datas of patients who underwent low rectal cancer (LRC) resection with modified terminal ileum cannula ileostomy (mTICI) or conventional ileal loop-type ileostomy, by comparing the clinical curative effects of the two groups, this study shall investigate the safety and efficacy of mTICI. MethodsA total of 60 patients with low anterior resection for rectal cancer in Jiangsu Subei People′s Hospital from September 2016 to August 2018 were selected as the subjects of the study. Among them, twenty-five cases were treated with mTICI, and the other group was conventional ileal loop-type ileostomy (n=35), grouped according to defunction stoma. The datas of the two groups were compared and analyzed, including general and pathological datas, intraoperative and postoperative recovery datas, postoperative complications and follow-up results. ResultsNo anastomotic leakage occurred in both groups after surgery. The length of the postoperative stay was (8.68±0.95) days in the mTICI group and (14.46±1.20) days in the loop ileostomy group, the difference between the two groups is statistically significant (t=13.00, P<0.01), including time for the initial and reversal operations. In the mTICI group, the total cost of patients were (59 284.52±5 712.63) and (75 128.77±10 238.05) in the loop ileostomy group, the difference between the two groups is statistically significant (t=6.99, P<0.01). ConclusionCompared with loop ileostomy, choosing mTICI can reduce the length of the postoperative stay, the hospitalization cost is low, the burden caused by the second surgery is avoided, and the same prevention as loop ileostomy can be achieved. It′s an alternative defunction stoma in the anus-preserving surgery for low rectal cancer.