切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 27 -31. doi: 10.3877/cma.j.issn.1674-3946.2022.01.010

论著

预防性回肠造口对腹腔镜直肠癌保肛患者术后肛门功能和心理因素状况的影响
朱汉建1, 徐家明1, 高进2, 刘壮壮2, 房永坤2, 赵琪1, 严成2, 王道荣2, 汤东2,()   
  1. 1. 225001 江苏扬州,扬州大学临床医学院
    2. 225001 江苏扬州,扬州大学附属苏北医院(江苏省苏北人民医院)胃肠外科,扬州大学-扬州市普通外科研究所
  • 收稿日期:2021-02-25 出版日期:2022-02-26
  • 通信作者: 汤东

The effect of preventive ileostomy on anal function and psychological factors in patients with rectal cancer after laparoscopic surgery

Hanjian Zhu1, Jiaming Xu1, Jin Gao2, Zhuangzhuang Liu2, Yongkun Fang2, Qi Zhao1, Cheng Yan2, Daorong Wang2, Dong Tang2,()   

  1. 1. Clinical Medical College, Yangzhou University, Yangzhou Jiangsu Province 225001, China
    2. Department of Gastrointestinal Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu Province Hospital, Clinical Medical College, Yangzhou University, Yangzhou Jiangsu Province 225001, China
  • Received:2021-02-25 Published:2022-02-26
  • Corresponding author: Dong Tang
  • Supported by:
    Social Development-Health Care Project of Yangzhou, Jiangsu Provice(YZ2021075); High-level talent “six one projects” top talent scientific research project of jiangsu Province(LGY2019034); Jiangsu Province Postgraduate Training Innovative Engineering Graduate Research and Practice Innovation Program(SJCX21_1644)
引用本文:

朱汉建, 徐家明, 高进, 刘壮壮, 房永坤, 赵琪, 严成, 王道荣, 汤东. 预防性回肠造口对腹腔镜直肠癌保肛患者术后肛门功能和心理因素状况的影响[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(01): 27-31.

Hanjian Zhu, Jiaming Xu, Jin Gao, Zhuangzhuang Liu, Yongkun Fang, Qi Zhao, Cheng Yan, Daorong Wang, Dong Tang. The effect of preventive ileostomy on anal function and psychological factors in patients with rectal cancer after laparoscopic surgery[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(01): 27-31.

目的

探讨预防性造口对腹腔镜直肠癌保肛患者术后肛门功能、生活质量以及心理状况的影响。

方法

收集2018年9月至2020年9月62例行腹腔镜下直肠癌低位前切除术(L-LAR)患者的临床资料,根据术式不同将其分为末端回肠造口组(n=25例)和未造口组(n=37例)。采用SPSS19.0统计软件分析数据,围手术期相关指标、大便失禁评分、生活质量核心量表、健康问卷评分量表等计量资料以(

xˉ
±s)表示,采用独立样本t检验,并发症等计数资料用χ2检验。P<0.05为差异有统计学意义。

结果

两组患者术后Wexner大便失禁评分均逐渐降低,造口组改善更为显著(P<0.05)。生存质量量表评分中,造口组患者躯体功能评分在术后1、3个月较高,总体健康状况评分在术后1、3、6个月均较高,腹泻评分在术后1、3个月均低于未造口组(P<0.05)。造口组患者广泛焦虑障碍量表评分在术后1、3个月较高,(P<0.05),在造口还纳后焦虑心理消失,未造口组患者术后均无焦虑心理。健康问卷抑郁量表评分两组患者在各随访时间点比较差异无统计学意义(P>0.05)。

结论

预防性造口有助于患者术后肛门功能的更快恢复、短期内的生活质量更好且不会造成患者心理抑郁,但会引起患者轻度焦虑,该心理状态在造口还纳后消失。

Objective

To investigate the effect of prophylactic colostomy on anus function,quality of life and psychological status of patients with rectal cancer after laparoscopy.

Methods

Clinical data of 62 patients who underwent laparoscopic low anterior resection of rectal cancer(L-LAR)from September 2018 to September 2020 were collected and divided into terminal ileostomy group(n=25 cases)and non-ileostomy Group(n=37 cases)according to different surgical methods. SPSS19.0 statistical software was used to analyze. Perioperative related indicators,fecal incontinence score,quality of life Core scale,health questionnaire score scale are expressed as(

xˉ
±s),independent t test is used,and count data such as complications are expressed as χ2 test,P<0.05 was considered statistically significant.

Results

Postoperative Wexner fecal incontinence scores was gradually decreased,the improvement in the stoma group was more significant(P<0.05). In the quality of life scale score,the physical function score of the stoma group was higher at 1st and 3rd month after surgery,the overall health score was higher at 1st、3rd、6th month after surgery,and the diarrhea score was lower than those of the non-ostomy group at 1st and 3rd month after surgery(P<0.05). he scores of the wide anxiety disorder scale were higher in the ostomy group 1 and 3 months after surgery(P<0.05). The anxiety disappeared after the stoma was accepted,While no anxiety in the non-stoma group. psychological. There was no significant difference in health questionnaire depression scale score between the two groups at each follow-up time point(P>0.05).

Conclusion

Preventive ostomy can help patients to recover quickly postoperative anal function,improve the quality of life in the short term,and will not cause psychological depression,but will cause mild anxiety in patients,the psychological state disappeared after the ostomy repay.

表1 62例腹腔镜直肠癌保肛不同术式两组患者一般资料对比[(
xˉ
±s),例]
表2 62例腹腔镜直肠癌保肛不同术式两组患者围手术期相关指标比较(
xˉ
±s
表3 62例腹腔镜直肠癌保肛不同术式两组患者术后肛门功能与心理状况评价[(
xˉ
±s),分]
表4 62例腹腔镜直肠癌保肛不同术式两组患者术后生活质量评价[(
xˉ
±s),分]
[1]
韩加刚,王振军. 低位直肠癌保肛手术方式选择[J]. 中国实用外科杂志201939(7):676-680.
[2]
Wu Y,,Zheng H,,Guo T,et al. Temporary Diverting Stoma Improves Recovery of Anastomotic Leakage after Anterior Resection for Rectal Cancer[J]. Sci Rep20177(1):15930.
[3]
Chapman Jr WC,,Subramanian M,,Jayarajan S,et al. First,Do No Harm:Rethinking Routine Diversion in Sphincter-Preserving Rectal Cancer Resection[J]. J Am Coll Surg2019228(4):547-556.
[4]
Ihnat P,,Gunkova P,,Peteja M,et al. Diverting ileostomy in laparoscopic rectal cancer surgery:high price of protection[J]. Surg Endosc201630(11):4809-4816.
[5]
刘德洪,黄江平. 低位直肠癌Dixon保肛手术联合预防性回肠造口的应用效果观察[J/CD].中华普外科手术学杂志(电子版)201812(3):254-257.
[6]
Tao K,,Gao J. Risk factors for anastomotic leakage after rectal cancer surgery[J]. Zhonghua wei chang wai ke za zhi201821(4):384-387.
[7]
Li J,,An Y,,Wu G,et al. Incidence and risk factors for anastomotic leakage after anterior resection for rectal cancer[J]. Zhonghua wei chang wai ke za zhi201821(4):413-418.
[8]
Chen JW,,Chang WJ,,Zhang ZY,et al. Risk factors of anastomotic leakage after robotic surgery for low and mid rectal cancer[J]. Zhonghua wei chang wai ke za zhi202023(4):364-369.
[9]
吴清,陈海军,周进. 直肠癌全系膜切除术后吻合口漏形成的危险因素分析[J/CD]. 中华普外科手术学杂志(电子版)202115(1):43-45.
[10]
Salamone G,,Licari L,,Agrusa A,et al. Usefulness of ileostomy preventive stoma after anterior resection of rectum on prevention of anastomotic leakage A retrospective analysis[J]. Ann Ital Chir201687:155-160.
[11]
Zhou MW,,Wang ZH,,Chen ZY,et al. Advantages of Early Preventive Ileostomy Closure after Total Mesorectal Excision Surgery for Rectal Cancer:An Institutional Retrospective Study of 123 Consecutive Patients[J]. Dig Surg201734(4):305-311.
[12]
Phan K,,Oh L,,Ctercteko G,et al. Does a stoma reduce the risk of anastomotic leak and need for re-operation following low anterior resection for rectal cancer:systematic review and meta-analysis of randomized controlled trials[J]. J Gastrointest Oncol201910(2):179-187.
[13]
Emmanuel A,,Chohda E,,Lapa C,et al. Preventive Stomas Result in Significantly More Short-Term Complications Following Low Anterior Resection for Rectal Cancer[J]. World J Surg201842(11):3755-3764.
[14]
Fratric I,,Radovanovic Z,,Radovanovic D,et al. Value of Protective Stoma in Rectal Cancer Surgery[J]. Med Pregl201669(3-4):73-78.
[15]
Yao H,,An Y,,Zhang Z. The application of preventive stomas after low anterior resection of rectal cancer[J]. Surg Today201949(6):451-459.
[16]
Pham H,,Torres H,,Sharma P. Mental health implications in bladder cancer patients:A review[J]. Urol Oncol201937(2):97-107.
[17]
Park YY,,Yang SY,,Han YD,et al. Predictive Factors for Bowel Dysfunction After Sphincter-Preserving Surgery for Rectal Cancer:A Single-Center Cross-sectional Study[J]. Dis Colon Rectum201962(8):925-933.
[18]
Gadan S,,Floodeen H,,Lindgren R,et al. Does a Preventive Stoma Impair Anorectal Function After Low Anterior Resection of the Rectum for Cancer?A 12-Year Follow-up of a Randomized Multicenter Trial[J]. Dis Colon Rectum201760(8):800-806.
[1] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[2] 吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[3] 周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[4] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[5] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[6] 郑民华, 蒋天宇, 赵轩, 马君俊. 中国腹腔镜直肠癌根治术30年发展历程与未来[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 591-595.
[7] 池畔, 黄胜辉. 中国腹腔镜直肠癌根治术30年来的巨大进步[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 596-600.
[8] 李明, 屠松, 闫鹏, 钱军, 高鹏程, 许文山, 杨发英, 胡振涛, 单永玮. 应用前列腺电切镜引导置管治疗直肠低位吻合口漏研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 603-606.
[9] 李玲, 刘亚, 李培玲, 张秀敏, 李萍. 直肠癌患者术后肠道菌群的变化与抑郁症相关性研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 607-610.
[10] 赵梓竣, 兰运升. 改良一针法末端回肠造口术对低位直肠癌保肛术后应激反应及安全性的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 611-614.
[11] 吴胜伟, 王志伟, 陈贵进, 刘序, 吴晓翔. 系膜肥厚低位直肠癌患者改良NOSES Ⅰ式手术的临床效果评价[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 615-618.
[12] 庄宝雄, 邓海军. 单孔+1腹腔镜直肠癌侧方淋巴结清扫术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 601-601.
[13] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[14] 梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
[15] 严虹霞, 王晓娟, 张毅勋. 2 型糖尿病对结直肠癌患者肿瘤标记物、临床病理及预后的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 483-487.
阅读次数
全文


摘要