经腹-会阴联合直肠癌根治术后经腹膜外造口对患者旁疝与排便功能的影响

目的探讨经腹-会阴联合直肠癌根治术后经腹膜外造口对患者旁疝与排便功能的影响。 方法选择2016年1月至2017年6月，广元市中心医院行经腹-会阴联合直肠癌根治术78例患者的临床资料。其中经腹膜外造口者40例为观察组，经腹膜内造口者38例为对照组，2组患者均于围手术期接受全程护理。比较2组手术指标、术后并发症发生情况及排便功能。 结果观察组术中出血量、住院时间分别为（104.24±39.08）ml和（15.62±3.10）d，与对照组（120.46±47.35）ml和（17.20±2.95）d，差异有统计学意义（P<0.05）；观察组手术时间、造口时间、术后切口愈合时间分别为（233.12±40.50）min、（21.87±9.23）min和（7.31±0.28）d，与对照组（231.38±39.04）min、（20.95±9.14）min和（7.05±0.34）d，差异无统计学意义（P>0.05）。观察组排便功能优良率显著高于对照组，差异有统计学意义（67.50% vs 34.21%，P<0.05）。观察组造口旁疝的发生率显著低于对照组，差异有统计学意义（2.50% vs 18.42%，P<0.05）；但2组间造口出血、造口水肿、造口回缩或脱垂等发生率比较，差异无统计学意义（P>0.05）。 结论经腹-会阴联合直肠癌根治术后经腹膜外造口可显著降低术后造口旁疝的发生率，促进其排便功能的恢复，整体疗效优于经腹膜内造口。

Effect of extraperitoneal colostomy after abdominoperineal radical resection of rectal cancer on incidence of parastomal hernia and defecation function

ObjectiveTo investigate the effect of extraperitoneal colostomy after abdominoperineal radical resection of rectal cancer on parastomal hernia and defecation function. MethodsThe subjects of the study were 78 patients undergoing abdominoperineal radical resection in Guangyuan City Central hospital from January 2016 to June 2017. Of these, 40 patients undergoing extraperitoneal colostomy were in the observation group, and 38 patients undergoing intraperitoneal colostomy were in the control group. The patients in the two groups received full nursing care during perioperative period. The surgical indexes, postoperative complications and defecation function between the two groups were compared. ResultsThe amount of intraoperative bleeding and length of hospital stay in the observation group were (104.24±39.08) ml and (15.62±3.10) days, respectively, significantly different from that in the control group (120.46±47.35) ml and (17.20±2.95) days (P<0.05). The operation time, stoma time and wound healing time of the observation group were (233.12±40.50) minutes, (21.87±9.23) minutes and (7.31±0.28) days, respectively, and there was no significant difference comparing to control group, (231.38±39.04) minutes, (20.95±9.14) minutes and (7.05±0.34) days (P>0.05). The excellent and good rate of defecation function in the observation group was significantly higher than that in the control group (67.50% vs 34.21%, P<0.05). The incidence of parastomal hernia in the observation group was significantly lower than that in the control group (2.50% vs 18.42%, P<0.05). There were no significant differences in the incidence of bleeding, edema, retraction or prolapse between the two groups (P>0.05). ConclusionExtraperitoneal colostomy after abdominoperineal radical resection of rectal cancer can significantly reduce the incidence of perioperative parastomal hernia and promote the recovery of defecation function. The overall curative effect is better than that of intraperitoneal colostomy.