直肠癌Miles术中造口方法的临床研究

目的　评价腹膜外结肠造口并一期开放在直肠癌Miles术中的临床应用价值。　方法　回顾性分析研究 2 18例直肠癌Miles手术的临床资料 ,其中 150例 (治疗组 )行腹膜外结肠造口并一期开放术 ,68例 (对照组 )行传统的腹膜内结肠造口分期开放术。　结果　所有病例经 2年以上的随访 ,治疗组有 4例出现造口周围皮肤炎 ,1例发生造口旁疝 ,并发症发生率为 3 .3 3 % ,55例病人获排便感觉。对照组造口并发症发生率为 3 3 .8% ,其中造口周围皮肤感染 1.47% (1例 ) ,造口回缩 4.41% (3例 ) ,造口狭窄 14 .71% (10例 ) ,腹腔内疝 4.41% (3例 ) ,造口旁疝 4.41% (3例 ) ,造口脱垂 4.41% (3例 ) ;无一例病人有排便感。两组在并发症发生率及排便感觉上有显著性差异 (P <0 .0 1)。　结论　Miles手术时采用腹膜外结肠造口并一期开放术 ,较传统术式并发症少 ,术后管理容易 ,排便功能好

Clinical Study of Colostomy in Miles'Operation of Rectal Carcinoma

Objective To evaluate the clinical value of the extraperitoneal colostomy with opening stoma meanwhile in Miles' operation of rectal carcinoma.Methods 286 patients with rectal carcinoma received the Miles' operation from January 1991 to December 2000. The clinical data were retrospectively analyzed. Of them, 150 cases ( therapy group) had an extraperitoneal colostomy with open stoma, another 68 cases (control group ) underwent the traditional Miles' operation. Stomal complications and functions of defecation in the two groups were compared. Results All patients were followed up for over 2 years. In the therapy group,only 4 cases suffered from skin inflammation around the colostomy, and one suffered from paracolostomy hernia. The morbidity of complications was about 3.33%,and 55 patients got defecation responses. The complication rate was 33.8% in the control group. Among them,1 case (1.47%) had skin inflammation around the colostomy,3(4.41%) had colostomy retraction,10(14.71%) had colostomy stenosis,3(4.41%) had intra abdomen hernia,3(4.41%) had paracolostomy hernia,3(4.41%)had stomal prolapse, and no one got defecation responses. There was a significant difference between the two groups ( P <0.01). Conclusion The procedure of extraperitoneal colostomy with opening stoma has less complications, better functions of defecation and easier management after the operation.