腹腔镜Miles术后肠造口相关并发症分析

目的探讨腹腔镜Miles术后肠造口相关并发症的发病率及原因。方法对121例行腹腔镜Miles术患者进行随访和回顾性分析。结果 121例患者都在腹腔镜下完成降结肠、乙状结肠及直肠的分离,无中转开腹,行经腹膜内腹直肌型肠造口（A组）43例,经腹膜外隧道及腹直肌型肠造口（B组）78例,应用吻合器实施乙状结肠皮肤吻合造口115例,无手术死亡。112例（92.6%,112/121）患者术后随访3-90个月,中位随访期33个月,9例失访。术后造口相关并发症总的发生率为16.1%（18/112）,两组术后造口相关并发症的发生率A组为37.8%,B组为5.3%,两组比较差异有统计学意义（P〈0.05）,B组术后造口相关并发症低于A组。结论腹腔镜Miles术后肠造口相关并发症的发病率与造口的方式有关,经腹膜外隧道的结肠造口是理想的造口方式。

Analysis of stoma-related complications after laparoscopic-assisted Miles operation

Objective To explore the morbidity and cause of stoma-related complications after laparoscopic-assisted Miles operation.Methods 121 patients who underwent laparoscopic-assisted Miles operation from July 2000 to April 2009 were followed up and reviewed retrospectively.Results All dissections of descending colon,sigmoid colon and rectum were accomplished laparoscopically with no conversion. 43 cases received the procedure of colostomy through the rectus abdominis peritoneally （group A）,78 cases through extraperitoneal tunnel and the rectus abdominis （group B）. 115 cases of colostomy were created by applying stapler to anastomosis of sigmoid colon and abdominal skin,no operative death occurred. 112 patients（92.6%,112/121）were followed up for 3 to 90 months （median,33 months）,9 cases were lost. The postoperative stoma-related complications rate was 16.1%（18/112）. Significant difference were found in stoma-related complications（A group 37.8% vs B group 5.3%,P〈0.05）,less stoma-related complications were found in group B.Conclusion Morbidity of postoperative stoma-related complications was related to procedure of colostomy,colostomy through extraperitoneal tunnel is the ideal procedure in laparoscopic-assisted Miles operation.