腹膜外结肠造口术的围术期处理及造口功能的临床评估

【目的】探讨腹膜外乙状结肠造口术的围术期处理及其功能状况。【方法】回顾性分析随诊1～5年的153例接受miles手术病人的临床资料。患者均按规范化围术期处理,81例(治疗组)施行腹膜外乙状结肠造口并一期开放术,72例(对照组)施行传统的乙状结肠造口术,比较两组病人的与造口有关的并发症和造口功能状况。【结果】治疗组有6例病人发生造口有关的并发症,发生率为7.4%(6/81);按照作者的评分法,其造口功能状况优良率在术后6个月和12个月分别为55.3%和75.3%。对照组有20例病人发生造口有关的并发症,并发症发生率为27.8%(20/72);其造口功能状况优良率在术后6个月和12个月分别为34.7%和47.2%。两组在两方面比较差异均有显著性(P<0.05)。【结论】腹膜外乙状结肠造口并一期开放术按规范化围术期处理原则施行,与传统方法比较,并发症发生率降低并有较佳的术后效能,能提高病人的生活质量。

Clinical Study on Perioperative Management and Postoperative Function of the Extraperitoneal Sigmoidostomy

[Objective]To investigate the perioperative management and postoperative function of the extraperitioneal sigmoidostomy.[Methods]One hundred seventy-one patients with low rectal cancer received the Mile's operation from Aug 1999 to Aug 2003.Clinical data of 153 patients followed up for 1~5 years were retrospectively analyzed . According to uniform perioperative management standards, 81 cases (therapy group) received the extraperitoneal sigmoidostomy with open stoma,other 72 cases{control group} underwent the traditional sigmoidostomy . Sigmoidostomy-related complications and stomal function in the two groups were compared.[Results]Sigmoidostomy-related complications happened in 6 patients(7.4%) in the therapy group.According to our marking way,the satisfaction rate of stomal function was 55.5%(after 6 months),and 75.3%(after 12 months).On the contrary, sigmoidostomy-related complications happened in 20 patients(27.8%) in the control group .The statisfaction rate of stomal function was 34.7%(after 6 months),and 47.2%(after 12 months).There was significant difference in the two aspects between two groups (P<0.05).[Conclusion]According to uniform perioperative management standards,the extraperitoneal sigmoidostomy with open stoma has fewer complications and better stomal function,could improve the life quality of the patients.