| 摘要: |
| 目的：探讨直肠癌低位前切除术中预防性造口与吻合口漏发生的关系。方法：对长海医院2005年1月至2006年10月期间施行直肠癌低位前切除(吻合口高度≤6 cm)的270例病例进行研究,共有113例施行预防性造口(41.9%)，将临床及病理资料建立数据库，利用SPSS 10.0 软件对是否预防性造口患者的吻合口漏发生率进行χ2检验。结果：低位前切除的患者中20例发生症状性吻合口漏,发生率7.4%。症状包括：腹痛(37%)、脉搏增快(53%)、发热(47%)、白细胞升高(53%)、盆腔引流液性状改变(68%)、肛门流脓血性液(26%)、其他(10%),平均年龄57.8岁,吻合口高度皆≤6 cm,没有病例因吻合口漏死亡。其中预防性造口组发生4例漏(3.5%),未造口组发生16例(10.2%),P=0.04。在有术前放疗史的24例患者中预防性造口率达到75%,其中18例预防性造口者无一发生漏(0/18),而未造口者却有2例漏(2/6),经Fisher精确概率法检验P=0.054。在做保护措施的142例低位前切除病例中,漏发生率为4.9%(7例),而剩余未做任何保护性措施的128例中吻合口漏发生率却高达10.2%(13例),P=0.10。有预防性造口的4例吻合口漏皆经保守治疗缓解,而未造口的16例漏中有8例因症状严重需手术干预,其中1例发生弥漫性腹膜炎。两组平均进食时间也有明显差异(P<0.01),但两组术后肠梗阻发生率(P=0.24)及住院天数(P=0.91)皆无明显差异。结论：吻合口漏仍是目前直肠癌前切除术后的主要并发症,预防性造口可以明显降低高危人群吻合口漏的发生率。考虑到吻合口漏有其不可预见性,建议吻合口高度低于6 cm的低位前切除病例行预防性造口。 |
| 关键词: 回肠造口术 吻合口漏 低位前切除术 直肠肿瘤 |
| DOI：10.3724/SP.J.1008.2008.00804 |
| 投稿时间：2007-12-14修订日期：2008-03-17 |
| 基金项目: |
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| Defunctioning stoma in low anterior resection for rectal carcinoma:a clinical analysis of 113 cases |
| HU Shi-jie1,CONG Zhi-jie2*,ZHANG Chuang3 |
| (1.Jianmin Colorectal & Anal Hospital of Ningbo,Ningbo 315040,China; 2.Department of Clinical Teaching(Surgery),Changhai Hospital,Second Military Medical University,Shanghai 200433;3.Department of General Surgery,Changhai Hospital,Second Military Medical University,Shanghai 200433) |
| Abstract: |
| Objective：To discuss the relationship between defunctionign stoma in low anterior resection for rectal carcinoma and the incidence of anastomotic leakage.Methods: Totally 270 patients who received low anterior resection for rectal carcinoma(with the distance between anastomosis and anal edge being 6 cm or less) from Jan.2005 to Oct.2006 were included in the present study.Defunctioning stoma was performed in 113(41.9%) patients considered with high risk of anastomotic leakage.The clinicopathological data were used to construct database.SPSS 10.0 software was used to analyze the incidences of anastomosis leakage in patients with and without receiving defunctioning stoma.Results: There were 20(7.4%) leakages in the 270 cases.The symptoms included abdominal pain(37%),increase of pulse(53%),fever(47%),leukocytosis(53%),pelvic fluid properties change(68%),anal discharge of bloody fluid(26%) and others(10%).The average age of patients with leakage was 57.8 years.No death was caused by anastomotic leakage.Four(3.5%) leakages happened in defunctioning stoma group,and 16(10.2%) leakages happened in non-stoma group(P=0.04).Eighteen(75%) of the 24 patients with preoperative radiotherapy history received defunctioning stoma and none of them had leakage.Two of the 6 cases who had preoperative radiotherapy history receiving no defunctioning stoma had anastomotic leakages; the fisher exact probability test showed P=0.054.The leakage rate was 4.9% (7 cases) in 142 cases who had received protective measures during low anterior resection and the rate was 10.2%(13 cases) in the rest 128 cases who had not received any protective measures(P=0.10).Leakages subsided with conservative treatment in the 4 patients with stoma,but 8 patients without stoma had severe symptoms and required surgical intervention; one developed peritonitis.The average fasting periods were significantly different between the 2 groups(P<0.01).The postoperative obstruction incidence(P=0.24) and hospitalization stay(P=0.91) were not significantly different between the 2 groups.Conclusion: Anastomotic leakage is still the most important complication of anterior resection for rectal cancer,and a defunctioning stoma can undoubtedly reduce the rate of anastomotic leakage in high-risk patients.It is suggested that all the anterior resection cases with anastomotic height of or less than 6 cm should be considered for defunctioning stoma. |
| Key words: ileostomy anastomotic leakage low anterior resection rectal neoplasms |
