预防性回肠末端造口在腹腔镜低位直肠癌根治性保肛手术中的应用体会

发布时间：2018-06-15 07:09

本文选题：腹腔镜低位直肠癌根治术 + 保肛手术　；参考：《郑州大学》2016年硕士论文

【摘要】：目的探讨预防性回肠末端造口术在腹腔镜低位直肠癌根治性保肛手术中的可行性、安全性及其临床疗效。方法随机对照研究2013年2月至2013年4月在河南省人民医院胃肠外科行腹腔镜低位直肠癌根治手术的96例患者,将其随机分为实验组(预防性造口)与对照组(不进行预防性造口),每组各48例。实验组患者常规进行回肠末端预防性双腔造口并在术前术中经家属同意并签字,根治术后3个月还纳预防性造口。对照组患者给予传统常规方式吻合,不进行预防性造口。研究中,共计86例患者完成试验,其中实验组44例,对照组42例。观察指标如下:1、分别记录两组患者一般情况并统计分析。2、记录并统计手术耗时、术中总出血量等手术情况比较。3、记录并统计术后肛门首次排气时间、术后首次下床活动时间、术后补液总天数、以及平均住院日等指标情况。4、记录并统计两组患者术前以及术后第2天,第5天WBC、CRP以及前白蛋白实验室检测结果。5、记录并统计两组患者术后吻合口瘘、腹腔感染、吻合口梗阻、术后尿潴留及肺部感染等并发症的发生情况。6、记录并统计两组患者术后两周,术后3个月,术后半年肛门功能的恢复情况,并采用徐忠五项十分法评分并分别进行统计分析。结果1、实验组和对照组在一般情况方面比较无明显统计学差异。(p0.05)。2、与对照组相比,实验组在手术时间略长(162.21±25.67)/(179.50±30.86分钟(p=0.059)、术中出血量(76.71±24.12)/(75.95±25.08)毫升(p=0.8864)等手术情况无明显统计学差异。3、实验组术后第2天经口流质饮食,对照组与肛门排气后清流质饮食;术后补液总天数(d)比对照组明显缩短(4.1±0.9)/(6.4±1.5)d(p=0.000);在术后恢复过程中实验组患者术后首次排气时间明显早于对照组(2.1±1.1)/(4.8±1.3)d(p=0.000);术后首次下床时间(d)也比对照组提前(1.8±0.9)/(3.9±1.8)d(p=0.000)。而且对比对照组,平均住院日(d)(8.7±1.2)/(12.9±2.1)d(p=0.000)也明显缩短。4、两组患者术前及术后第2天wbc、crp、白蛋白以及前白蛋白结果无明显差异(p0.05);第5天wbc、crp指标实验组降低有统计学意义,实验组前白蛋白升高具有统计学差异(p0.05)。5、实验组患者术后无一例发生吻合口瘘,对照组患者术后有5例患者出现吻合口瘘,均经双腔引流管冲洗后好转。实验组术后并发症总发生率6.28%,对照组为21.43%,p=0.009,两组存在明显统计学差异(p0.05)。6、两组患者术后14天时,总体生活质量无明显差异均不理想;术后3个月两组患者肛门功能均有很大程度恢复,实验组患者逐渐适应造口,总体生活质量显著优于对照组;术后半年,实验组造口已还纳3个月,排便功能恢复情况优于对照组。结论在腹腔镜低位直肠癌保肛手术中,施行预防性回肠末端双腔造口术,可降低患者术后吻合口瘘发生率,促进患者快速康复,患者术后肛门功能明显改善,生活质量得以提高。
[Abstract]:Objective to investigate the feasibility, safety and clinical effect of prophylaxis ileostomy in laparoscopic radical anal preservation for low rectal cancer. Methods from February 2013 to April 2013, 96 patients underwent laparoscopic radical resection of low rectal cancer in Henan Provincial people's Hospital. They were randomly divided into two groups: the experimental group (prophylactic orifices) and the control group (48 cases in each group). The patients in the experimental group were treated with prophylactic double-lumen ileostomy before operation and signed by their relatives before operation. The patients received prophylactic anastomosis 3 months after radical operation. Patients in the control group were given conventional anastomosis without prophylactic orifice. In the study, a total of 86 patients completed the test, including 44 cases in the experimental group and 42 cases in the control group. The observation measures were as follows: 1. The general situation and statistical analysis of the two groups were recorded and analyzed. The operation time, the total amount of blood lost during the operation, and so on, were recorded and counted respectively. The time of the first exsufflation of anus and the time of the first time of getting out of bed after operation were recorded and counted. The total days of fluid resuscitation and the average hospital stay. 4. The results of WBCU CRP and prealbumin laboratory test were recorded and counted before operation and on the second day and the fifth day after operation, and the anastomotic fistula was recorded and counted in both groups. The incidence of postoperative complications such as abdominal infection, anastomotic obstruction, postoperative urinary retention and pulmonary infection were recorded and counted. The recovery of anal function was recorded and counted in two weeks, three months and six months after operation. Xu Zhong's five tenths method was used to score the scores and statistical analysis was carried out respectively. Results 1. There was no significant difference in general situation between the experimental group and the control group. There was no significant difference in the operation time between the experimental group (162.21 卤25.67 / L, 179.50 卤30.86 minutes) and the intraoperative bleeding volume (76.71 卤24.12 卤25.08) ml (0.8864). There was no significant difference between the experimental group and the control group on the second day after operation. The total days of postoperative fluid resuscitation were significantly shorter than that of the control group (4. 1 卤0. 9 / P) and 6. 4 卤1. 5 卤1. 5 days after operation. The first postoperative exhaust time of the patients in the experimental group was significantly earlier than that in the control group (2. 1 卤1. 1 / 0. 8 卤1. 3 卤1. 3 卤1. 3) and the first time of getting out of bed was 1. 8 卤0. 9 卤1. 8 卤1. 8 days later than that in the control group. In comparison with the control group, the mean hospitalization days were 8.7 卤1.2 卤1.2 / L / L 12.9 卤2.1 / d ~ (0.000), respectively. There was no significant difference between the two groups in the results of pre-operation and postoperative wbcccrp, albumin and prealbumin, and the decrease of wbccrp on the 5th day was statistically significant in the experimental group, and there was no significant difference between the two groups before operation and on the second day after operation (P < 0.05), but there was no significant difference between the two groups (P > 0.05). There was no anastomotic leakage in the experimental group and 5 cases in the control group. The total incidence of postoperative complications was 6.28 in the experimental group and 21.43 in the control group. There was a significant difference between the two groups (p0.05. 6). There was no significant difference in the overall quality of life between the two groups on the 14th day after operation. Three months after operation, the anal function of the two groups recovered to a great extent, the patients in the experimental group gradually adapted to the orifice, the overall quality of life was significantly better than that in the control group, and half a year after the operation, the patients in the experimental group had received the operation for 3 months. The recovery of defecation function was better than that of the control group. Conclusion during laparoscopic anus-preserving surgery for low rectal cancer, the prophylactic operation of double ileostomy can reduce the incidence of anastomotic fistula, promote the rapid recovery of the patients, and improve the anal function of the patients after operation. The quality of life has improved.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.37

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