直肠癌低位前切除术后预防性造口的价值

目的探讨直肠癌低位前切除术中应用预防性回肠造口的价值。方法将136例行直肠癌低位前切除术的患者分为未行预防性造口组79例(A组),行预防性回肠造口组57例(B组),对比两组术后吻合口瘘、肠梗阻、切口感染、死亡的发生情况。结果A组吻合口瘘的发生率(12.7%)明显高于B组(1.8%)。两组术后肠梗阻发生率(5.1%,5.3%)和切口感染率(6.3%,14%)无明显差异。但A组中再次急诊开腹手术率(1.3%)明显高于B组(0%),且出现1例死亡病例。结论预防性回肠造口能明显降低直肠癌低位前切除术后吻合口瘘的发生,尤其对于伴有高危因素的病例,更应明智地选择预防性造口。

Evaluation of Defunctioning Ileostomy after Low Anterior Resection for Rectal Cancer

Objective To evaluate the value of defunctioning ileostomy in patients undergoing low anterior resection for rectal cancer.Methods There were 136 patients who underwent low anterior resection for rectal cancer.They were divided into two groups.Group A consisted of 79 patients who underwent straight anastomosis defunctioning without ileostomy and Group B consisted of 57 patients who underwent straight anastomosis with ileostomy.Postoperative data were compared between two groups in terms of anastomotic leak,ileus,incision infection,and mortality.Results The leakage rate was distinctly higher in Group A（12.7%）than in Group B（1.8%）.There were no significantly differences between the two groups in the rates of ileus（5.1%5.3%）and of incision infection（6.3%,14%）.But the rate of urgent abdominal reopertaion in Group A（1.3%）was higher than in group B（0%）.One patient in Group A died.Conclusion Defunctioning ileostomy undoubtedly decreased the rate of anastomotic leak in patients undergoing low anterior resection for rectal cancerAnd defunctioning stoma is a sensible choice especially in high-risk patients.