结肠内旁路保护低位直肠癌吻合口的手术技巧和疗效观察

doi:10.3877/cma.j.issn.1674-3946.2019.05.028

目的

探讨结肠内旁路保护低位直肠癌吻合口的手术技巧并评估其疗效。

方法

回顾性分析2012年1月至2018年5月期间140例拟行结肠内旁路低位直肠癌保肛手术患者(结肠内旁路组)以及同期收治的30例拟行回肠袢式造口低位直肠癌保肛手术患者(回肠造口组)资料。采用SPSS20.0统计软件分析，术中术后相关指标等用"均数±标准差"表示，采用独立t检验；术后Dukes分期比较、吻合口漏发生情况比较采用χ²分析；P<0.05代表差异有统计学意义。

结果

结肠内旁路组手术时间较回肠造口组明显缩短(P<0.05)；两组患者吻合口高度和术后Dukes分期差异无统计学意义(P>0.05)。结肠内旁路组术后首次肛门排气时间、首次进食时间、住院时间较回肠造口组明显缩短，住院费用较回肠造口组降低(P<0.05)。术后，结肠内旁路组明显低于回肠造口组(2.9% vs. 16.7%, χ²＝5.522, P<0.05)。结肠内旁路组吻合口漏后引流时间和术后2个月吻合口狭窄发生率均较回肠造口组明显降低(P<0.05)。

结论

结肠内旁路保护低位直肠癌吻合口手术是一种安全、有效的手术方式。

关键词: 直肠肿瘤, 外科吻合口, 空肠回肠旁路术, 治疗结果

Objective

To investigate the the surgical technique and evaluate the efficacy of internal colon bypass in the protection of anastomotic stoma of low rectal cancer.

Methods

A retrospective analysis was made on 140 patients who underwent anus-preserving operation for low rectal cancer combined with internal colon by-pass (the colonic bypass group) and 30 patients who underwent anus-preserving operation combined with loop ileostomy (the ileostomy group) from January 2012 to May 2018. SPSS20.0 statistical software was used to analyze. The intraoperative and postoperative related indicators were showed as " mean±standard deviation" , and compared with independent t test. Postoperative Dukes staging and anastomotic leakage were analyzed by chi square. P<0.05 meant a statistically significant difference.

Results

The operative time in the colon bypass group was significantly shorter than that in the ileostomy group (P<0.05). There was no significant difference in anastomotic height and postoperative Dukes staging between the two groups (P>0.05). Compared with ileostomy group, the first anal exhaust time and first feeding time of colon bypass group were significantly longer, the hospitalization time was significantly shorter, and the hospitalization cost was significantly lower (P<0.05). The incidence of anastomotic leakage was 2.9% in the colon bypass group and 16.7% in the ileostomy group. The difference between the two groups was statistically significant(χ²=5.522, P<0.05). The drainage time after anastomotic leakage and the incidence of anastomotic stenosis 2 months after operation in the colon bypass group were significantly lower than those in the ileostomy group (P<0.05).

Conclusion

Colon bypass is a safe and effective way to protect anastomotic stoma in low rectal cancer.

Key words: Rectal neoplasms, Surgical stomas, Jejunoileal bypass, Treatment outcome

表1 170例低位直肠癌保肛手术患者不同术式两组患者基线资料比较(±s)

组别	例数	性别(男/女)	年龄(岁)	肿瘤直径(cm)	肿块高度(cm)
回肠造口组	30	16/14	62.6±10.7	3.2 ±0.5	9.0±1.2
结肠内旁路组	140	73/67	62.9±10.3	3.2±0.6	9.0±1.3
χ²/t值	?	0.203	0.645	0.399	0.906
P值	?	>0.05	>0.05	>0.05	>0.05

表1 170例低位直肠癌保肛手术患者不同术式两组患者基线资料比较(±s)

组别	例数	性别(男/女)	年龄(岁)	肿瘤直径(cm)	肿块高度(cm)
回肠造口组	30	16/14	62.6±10.7	3.2 ±0.5	9.0±1.2
结肠内旁路组	140	73/67	62.9±10.3	3.2±0.6	9.0±1.3
χ²/t值	?	0.203	0.645	0.399	0.906
P值	?	>0.05	>0.05	>0.05	>0.05

表2 170例低位直肠癌保肛手术患者不同术式两组患者术后相关指标比较(±s)

组别	例数	首次肛门排气时间(h)	首次进食时间(h)	住院时间(d)	住院费用(万元)
回肠造口组	30	96.8±11.2	106.7±13.6	21.0±3.8	3.6±0.6
结肠内旁路组	140	79.7±10.3	85.9±11.0	11.9±2.0	2.4±0.4
t值	?	8.963	10.224	8.497	4.136
P值	?	<0.05	<0.05	<0.05	<0.05

表2 170例低位直肠癌保肛手术患者不同术式两组患者术后相关指标比较(±s)

组别	例数	首次肛门排气时间(h)	首次进食时间(h)	住院时间(d)	住院费用(万元)
回肠造口组	30	96.8±11.2	106.7±13.6	21.0±3.8	3.6±0.6
结肠内旁路组	140	79.7±10.3	85.9±11.0	11.9±2.0	2.4±0.4
t值	?	8.963	10.224	8.497	4.136
P值	?	<0.05	<0.05	<0.05	<0.05

表3 170例低位直肠癌保肛手术患者不同术式两组患者术后Dukes分期比较[例(%)]

组别	例数	A	B	C	D
回肠造口组	30	5(16.7)	14(46.7)	10(33.3)	1(3.3)
结肠内旁路组	140	31(22.1)	62(44.3)	36(25.7)	11(7.9)
χ²值	?	1.023	0.967	0.879	1.225
P值	?	>0.05	>0.05	>0.05	>0.05

表3 170例低位直肠癌保肛手术患者不同术式两组患者术后Dukes分期比较[例(%)]

组别	例数	A	B	C	D
回肠造口组	30	5(16.7)	14(46.7)	10(33.3)	1(3.3)
结肠内旁路组	140	31(22.1)	62(44.3)	36(25.7)	11(7.9)
χ²值	?	1.023	0.967	0.879	1.225
P值	?	>0.05	>0.05	>0.05	>0.05

表4 170例低位直肠癌保肛手术患者不同术式两组患者术后恢复情况比较[例(%)]

组别	例数	吻合口漏	引流时间[(±s)，d]	术后2个月吻合口狭窄
回肠造口组	30	5(16.7)	15.2±2.1	9(30.0)
结肠内旁路组	140	4(2.9)	7.9±1.1	9(6.4)
χ²值	?	5.522	8.796	10.158
P值	?	<0.05	<0.05	<0.05

表4 170例低位直肠癌保肛手术患者不同术式两组患者术后恢复情况比较[例(%)]

组别	例数	吻合口漏	引流时间[(±s)，d]	术后2个月吻合口狭窄
回肠造口组	30	5(16.7)	15.2±2.1	9(30.0)
结肠内旁路组	140	4(2.9)	7.9±1.1	9(6.4)
χ²值	?	5.522	8.796	10.158
P值	?	<0.05	<0.05	<0.05

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Surgical technique and efficacy of internal colon bypass in the protection of anastomotic stoma of low rectal cancer

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Surgical technique and efficacy of internal colon bypass in the protection of anastomotic stoma of low rectal cancer