切换至 "中华医学电子期刊资源库"
高级检索
中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2019, Vol. 08 ›› Issue (06) : 588 -595. doi: 10.3877/cma.j.issn.2095-3224.2019.06.008

所属专题： 文献；

论著

低位直肠癌保肛手术中回肠襻式造口与改良自闭式造口的对比研究
徐明皓1, 汤东2, 王伟2, 金芝祥3, 李智3, 张琪4, 吴晓清4, 唐小丽5, 王道荣2,†()   
  1. 1. 116044　大连医科大学第一临床学院
    2. 225001　扬州　江苏省苏北人民医院胃肠中心　扬州大学-扬州市普通外科研究所
    3. 116044　大连医科大学第二临床学院
    4. 225009　扬州大学医学院
    5. 410013　长沙，中南大学湘雅二医院普通外科
  • 收稿日期:2019-03-03 出版日期:2019-12-25
  • 通信作者: 王道荣
  • 基金资助:
    江苏省卫生厅科研基金(No.BE2015664)

A comparative study of ileal loop-type ileostomy and modified terminal ileum cannula ileostomy in anus preservation operation on low rectal cancer

Minghao Xu1, Dong Tang2, Wei Wang2, Zhixiang Jin3, Zhi Li3, Qi Zhang4, Xiaoqing Wu4, Xiaoli Tang5, Daorong Wang2,†()   

  1. 1. First Clinical College of Dalian Medical University, Dalian 116044, China
    2. Gastrointestinal Center of Jiangsu Subei People′s Hospital, Yangzhou University-Yangzhou Institute of General Surgery, Yangzhou 225001, China
    3. Second Clinical College of Dalian Medical University, Dalian 116044, China
    4. School of Medicine, Yangzhou University, Yangzhou 225009, China
    5. General Surgery, Xiangya Second Hospital, Central South University, Changsha 410013, China
  • Received:2019-03-03 Published:2019-12-25
  • Corresponding author: Daorong Wang
  • About author:
    Corresponding author: Wang Daorong, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

徐明皓, 汤东, 王伟, 金芝祥, 李智, 张琪, 吴晓清, 唐小丽, 王道荣. 低位直肠癌保肛手术中回肠襻式造口与改良自闭式造口的对比研究[J/OL]. 中华结直肠疾病电子杂志, 2019, 08(06): 588-595.

Minghao Xu, Dong Tang, Wei Wang, Zhixiang Jin, Zhi Li, Qi Zhang, Xiaoqing Wu, Xiaoli Tang, Daorong Wang. A comparative study of ileal loop-type ileostomy and modified terminal ileum cannula ileostomy in anus preservation operation on low rectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2019, 08(06): 588-595.

目的

探讨低位直肠癌保肛手术中应用改良自闭式造口的安全性和有效性，比较采用改良自闭式造口与回肠襻式造口两种造口方式的临床疗效。

方法

回顾性分析苏北人民医院胃肠外科2016年9月~2018年8月期间60例行低位直肠癌保肛手术患者的临床资料，根据预防性造口实施方式的不同分为：改良自闭式造口组25例，回肠襻式造口组35例。分析指标包括：一般资料及病理资料、术中及术后恢复情况、术后并发症及随访情况。

结果

两组患者均未发生吻合口漏，改良自闭式造口组患者术后总住院时间为（8.68±0.95）天，回肠襻式造口组患者术后总住院时间为（14.46±1.20）天，两组比较差异具有统计学意义（t=13.00，P<0.01），包括行一期造口及二期还纳手术的时间。改良自闭式造口组患者在院总花费为（59 284.52±5 712.63）元，回肠襻式造口组为（75 128.77±10 238.05）元，两组比较差异具有统计学意义（t=6.99，P<0.01）。

结论

相比回肠末端襻式造口，改良自闭式造口住院时间少、住院费用低，避免了造口旁疝及造口脱垂等造口相关并发症的出现，是低位直肠癌保肛术中可供选择的预造口方式。

关键词: 直肠肿瘤, 回肠造口术, 低位直肠癌, 吻合口漏, 预防性造口
Objective

Retrospective analysis of clinical datas of patients who underwent low rectal cancer (LRC) resection with modified terminal ileum cannula ileostomy (mTICI) or conventional ileal loop-type ileostomy, by comparing the clinical curative effects of the two groups, this study shall investigate the safety and efficacy of mTICI.

Methods

A total of 60 patients with low anterior resection for rectal cancer in Jiangsu Subei People′s Hospital from September 2016 to August 2018 were selected as the subjects of the study. Among them, twenty-five cases were treated with mTICI, and the other group was conventional ileal loop-type ileostomy (n=35), grouped according to defunction stoma. The datas of the two groups were compared and analyzed, including general and pathological datas, intraoperative and postoperative recovery datas, postoperative complications and follow-up results.

Results

No anastomotic leakage occurred in both groups after surgery. The length of the postoperative stay was (8.68±0.95) days in the mTICI group and (14.46±1.20) days in the loop ileostomy group, the difference between the two groups is statistically significant (t=13.00, P<0.01), including time for the initial and reversal operations. In the mTICI group, the total cost of patients were (59 284.52±5 712.63) and (75 128.77±10 238.05) in the loop ileostomy group, the difference between the two groups is statistically significant (t=6.99, P<0.01).

Conclusion

Compared with loop ileostomy, choosing mTICI can reduce the length of the postoperative stay, the hospitalization cost is low, the burden caused by the second surgery is avoided, and the same prevention as loop ileostomy can be achieved. It′s an alternative defunction stoma in the anus-preserving surgery for low rectal cancer.

Key words: Rectal neoplasms, Ileostomy, Low rectal cancer, Anastomotic leakage, Defunction stoma
图3 自闭式插管术中所见
表1 两组患者一般临床资料
项目 改良自闭式造口组（25例） 回肠襻式造口组（34例） χ2/t值 P值
年龄（岁） 61.52±10.30 59.74±9.31 0.90 0.49
性别 ? ? ? ?
? 　男 17 25 0.08 0.78
? 　女 8 10
BMI（kg/m2） 23.94±2.81 24.16±2.16 0.35 0.73
腹部手术史 ? ? ? ?
? 　有 6 8 0.01 0.92
? 　无 19 27
合并心肺脑疾病 ? ? ? ?
? 　有 10 12 0.21 0.65
? 　无 15 23
合并糖尿病 ? ? ? ?
? 　有 2 4 0.00 1.00
? 　无 23 31
ASA ? ? ? ?
? 　Ⅰ 13 18 0.01 0.99
? 　Ⅱ 9 13
? 　Ⅲ 3 4
表2 两组患者病理资料
组别 改良自闭式造口组（n=25） 回肠襻式造口组（n=35） χ2/t值 P值
肿瘤大小（cm） 5.84±1.55 6.03±1.34 0.500 0.62
肿瘤下缘距肛缘距离（cm） 4.68±0.90 4.49±0.89 0.83 0.41
清扫淋巴结（枚） 14（9，17.5） 12（9，16） -0.26* 0.80
转移淋巴结（枚） 0（0，1） 1（0，2） -1.00* 0.32
术后病理T分期 ? ? 1.17 0.76
? 　T1 2 1 ? ?
? 　T2 2 2 ? ?
? 　T3 6 11 ? ?
? 　T4 15 21 ? ?
TNM分期 ? ? 1.50 0.47
? 　Ⅰ 2 2 ? ?
? 　Ⅱ 12 12 ? ?
? 　Ⅲ 11 21 ? ?
表3 两组患者围手术期资料
? 改良自闭式造口组（n=25） 回肠襻式造口组（n=35） t值 P值
手术时间（min） 164.6±28.97 163±30.78 0.20 0.84
造口时间（min） 27.32±7.07 28.86±4.55 1.03 0.31
出血量（mL） 49.4±25.26 45.29±23.29 0.65 0.52
肠功能恢复时间（天） 2.08±0.7 1.89±0.63 1.12 0.27
进食时间（天） 2.68±0.58 2.43±0.50 1.83 0.07
术后住院时间（天） 8.00±1.38 15.83±2.77 13.00 <0.01
住院总花费（元） 59 284.52±5 712.63 75 128.77±10 238.05 6.99 <0.01
图4 自闭式插管术后恢复情况。4A：拔管前；4B：拔管
表4 两组患者术后并发症及随访情况
组别 改良自闭式造口组（n=25） 回肠襻式造口组（n=35） χ2值 P值
吻合口漏 0 0 0.00 1.00
造口出血 0 1 -- 1.00
造口感染 2 4 0.00 1.00
造口处疼痛 5 2 1.668 0.197
造口旁疝 0 3 0.81 0.37
造口脱垂 0 1 - 1.00
造口塌陷 0 1 0.81 1.00
吻合口狭窄 0 8 3.89 0.049
拔管后相关并发症（粪水性皮炎） 2 0 - 0.17
死亡病例 0 0 0.00 1.00
图5 经肛门碘油造影示吻合口通畅无渗漏
[1]
Bakker IS, Grossmann I, Henneman D, et al. Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit [J]. British Journal of Surgery, 2014, 101(4): 424-432.
[2]
Yun JA, Yong BC, Park YA, et al. Clinical manifestations and risk factors of anastomotic leakage after low anterior resection for rectal cancer [J]. Anz Journal of Surgery, 2015, 87(11): 908-914.
[3]
Rullier E, Denost Q, Vendrely V, et al. Low rectal cancer: classification and standardization of surgery [J]. Dis Colon Rectum, 2013, 56(5): 560-567.
[4]
Mozafar M, Sobhiyeh MR, Heibatollahi M. Anastomotic leakage following low anterior resection of rectal cancer considering the role of protective stoma [J]. Iranian Journal of Cancer Prevention, 2009, 2(1): 29-33.
[5]
李栋梁，王明，朱俊. 直肠癌前切除术后吻合口瘘相关因素分析 [J].中华胃肠外科杂志, 2016, 19(4): 418-421.
[6]
Gu WL, Wu SW. Meta-analysis of defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer: evidence based on thirteen studies [J]. World Journal of Surgical Oncology, 2015, 13(1): 9.
[7]
Lim SB, Yu CS, Kim CW, et al. Late anastomotic leakage after low anterior resection in rectal cancer patients: clinical characteristics and predisposing factors [J]. Colorectal Disease, 2016, 18(4): O135-O140.
[8]
Hua H, Xu J, Chen W, et al. Defunctioning cannula ileostomy after lower anterior resection of rectal cancer [J]. Diseases of the Colon & Rectum, 2014, 57(11): 1267-1274.
[9]
Chen D, Zhao H, Huang Q, et al. Application of spontaneously closing cannula ileostomy in laparoscopic anterior resection of rectal cancer [J]. Oncology Letters, 2017, 14(5): 5299-5306.
[10]
王道荣，徐明皓，汤东. 改良式回肠末端自闭式造口术在腹腔镜低位直肠癌保肛术中的应用价值 [J]. 中华消化外科杂志, 2018, 17(2): 188-193.
[11]
Zhang W, Lou Z, Liu Q, et al. Multicenter analysis of risk factors for anastomotic leakage after middle and low rectal cancer resection without diverting stoma: a retrospective study of 319 consecutive patients [J]. International Journal of Colorectal Disease, 2017, 32(34): 1-7.
[12]
Boyce SA, Harris C, Stevenson A, et al. Management of low colorectal anastomotic leakage in the laparoscopic Era [J]. Diseases of the Colon & Rectum, 2017, 60(8): 807-814.
[13]
Chi P, Huang S. Anastomotic leakage after rectal cancer surgery: classification and management [J]. Chinese Journal of Gastrointestinal Surgery, 2018, 24(4): 34-37.
[14]
Phillips BR, Harris LJ, Maxwell PJ, et al. Anastomotic leak rate after low anterior resection for rectal cancer after chemoradiation therapy [J]. American Surgeon, 2010, 76(8): 869-871.
[15]
Kawada K, Sakai Y. Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis [J]. World Journal of Gastroenterology, 2016, 22(25): 5718-5727.
[16]
Tsuruta A, Tashiro J, Ishii T, et al. Prediction of anastomotic leakage after laparoscopic low anterior resection in male rectal cancer by pelvic measurement in magNETsic resonance imaging [J]. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2017, 27(1): 54-59.
[17]
Shao Q, Lin G. Surgical skills in the prevention of anastomotic leakage after rectal neoplasm surgery [J]. Chinese Journal of Gastrointestinal Surgery, 2018, 21(4): 399-403.
[18]
Chow A, Tilney HS, Paraskeva P, et al. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases [J]. International Journal of Colorectal Disease, 2009, 24(6): 711-723.
[19]
Omundsen M, Hayes J, Collinson R, et al. Early ileostomy closure: is there a downside? [J]. Anz Journal of Surgery, 2012, 82(5): 352-354.
[20]
Matthiessen P, Olof Hallböök, Jörgen Rutegård, et al. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial [J]. Annals of Surgery, 2007, 247(4): 207-214.
[21]
Seo SI, Chang SY, Kim GS, et al. Characteristics and risk factors associated with permanent stomas after sphincter-saving resection for rectal cancer [J]. World Journal of Surgery, 2013, 37(10): 2490-2496.
[22]
Snijders HS, Van d BCBM, Wouters MWJM, et al. An increasing use of defunctioning stomas after low anterior resection for rectal cancer. Is this the way to go? [J]. European Journal of Surgical Oncology (EJSO), 2013, 39(7): 715-720.
[23]
Floodeen H, Hallböök O, Hagberg LA, et al. Costs and resource use following defunctioning stoma in low anterior resection for cancer-A long-term analysis of a randomized multicenter trial [J]. European Journal of Surgical Oncology (EJSO), 2017, 43(2): 330-336.
[24]
Gadan S, Floodeen H, Lindgren R, et al. Does a defunctioning stoma impair anorectal function after low anterior resection of the rectum for cancer? A 12-Year follow-up of a randomized multicenter trial [J]. Diseases of the Colon & Rectum, 2017, 60(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] 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.
[7] 张朝军, 袁新普. 腹腔镜辅助低位直肠癌根治术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 602-602.
[8] 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.
[9] 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.
[10] 赵磊, 刘文志, 林峰, 于剑, 孙铭骏, 崔佑刚, 张旭, 衣宇鹏, 于宝胜, 冯宁. 深部热疗在改善结直肠癌术后辅助化疗副反应及生活质量中的作用研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 488-493.
[11] 陈杰, 武明胜, 李一金, 李虎, 向源楚, 荣新奇, 彭健. 低位直肠癌冷冻治疗临床初步分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 494-498.
[12] 黄海洋, 邝永龙, 陈嘉胜. 基层医院结直肠肿瘤经自然腔道取标本手术30 例分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 510-518.
[13] 王灿, 樊昊, 张卫, 于冠宇. LARS 评分的研制回顾与应用现状[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 519-523.
[14] 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.
[15] 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.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号