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中华结直肠疾病电子杂志 ›› 2021, Vol. 10 ›› Issue (01) : 61 -69. doi: 10.3877/cma.j.issn.2095-3224.2021.01.009

所属专题: 文献

论著

低位直肠癌前切除术后预防性回肠造口方式对转流性结肠炎发病及转归的影响
吴迪1, 王楠1, 吴涛1, 张战胜1, 张波1, 杨振宇1, 韦明光1, 杨世荣1, 高鹏1, 乔庆1, 何显力1,()   
  1. 1. 710038 西安,空军军医大学唐都医院普通外科
  • 收稿日期:2020-07-05 出版日期:2021-02-25
  • 通信作者: 何显力
  • 基金资助:
    2019年陕西省社会发展领域一般项目(2019SF-004)

Effects of prophylactic ileostomy on incidence rate and outcome of diversion colitis after low anterior rectal resection due to rectal cancer

Di Wu1, Nan Wang1, Tao Wu1, Zhansheng Zhang1, Bo Zhang1, Zhenyu Yang1, Mingguang Wei1, Shirong Yang1, Peng Gao1, Qing Qiao1, Xianli He1,()   

  1. 1. Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
  • Received:2020-07-05 Published:2021-02-25
  • Corresponding author: Xianli He
引用本文:

吴迪, 王楠, 吴涛, 张战胜, 张波, 杨振宇, 韦明光, 杨世荣, 高鹏, 乔庆, 何显力. 低位直肠癌前切除术后预防性回肠造口方式对转流性结肠炎发病及转归的影响[J/OL]. 中华结直肠疾病电子杂志, 2021, 10(01): 61-69.

Di Wu, Nan Wang, Tao Wu, Zhansheng Zhang, Bo Zhang, Zhenyu Yang, Mingguang Wei, Shirong Yang, Peng Gao, Qing Qiao, Xianli He. Effects of prophylactic ileostomy on incidence rate and outcome of diversion colitis after low anterior rectal resection due to rectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2021, 10(01): 61-69.

目的

比较行预防性回肠单腔或双腔造口术对低位直肠癌前切除术后转流性结肠炎发病及转归的影响。

方法

回顾性分析2015年1月至2019年9月于空军军医大学唐都医院接受腹腔镜低位直肠癌前切除术+预防性回肠造口术的147例患者的病例资料。按入排标准从中选取68例,根据造口方式不同分为单腔组(31例)和双腔组(37例),收集两组患者的临床基本资料、首次手术(Ⅰ期)及造口还纳手术(Ⅱ期)的近期结果、采集造口后3~4个月及造口还纳后4~6个月结肠黏膜内镜下改变(水肿,出血或接触性出血)及相关临床症状(失功能肠段浆液、黏液、血性分泌物,腹痛,里急后重,腹泻)信息。

结果

两组患者基本资料具有可比性;除双腔组造口还纳手术时间低于单腔组外(50.00±7.55 min vs. 63.22±6.26 min,t=7.768;P<0.01),两组患者Ⅰ/Ⅱ期手术的手术时间、造口还纳距首次手术的时间、术中出血量、肠道功能恢复时间、住院时间及术后近期并发症的发生率差异均无统计学意义;双腔组患者转流性结肠炎发病率显著少于单腔组,差异有统计学意义(54.1% vs. 80.6%,χ2=5.328;P<0.05);双腔组患者中、重度转流性结肠炎比例低,严重程度低于单腔组,差异有统计学意义(16.2% vs. 51.6%,χ2=9.656;P<0.05);单腔组患者造口还纳后腹泻发生率高于双腔组,差异有统计学意义(29.0% vs. 8.1%,χ2=5.082;P<0.05)。

结论

低位直肠癌前切除术后预防性回肠单腔造口与双腔造口均安全可行;回肠双腔造口在预防转流性结肠炎的发生及改善转归等方面可能更具优势。

Objective

To compare the effects of single or double lumen prophylactic ileostomy on the incidence rate and outcome of diversion colitis after low anterior rectal resection due to rectal cancer.

Methods

From January 2015 to September 2019, 147 patients with low rectal cancer underwent laparoscopic anterior resection and prophylactic ileostomy in Tangdu Hospital of Air Force Military Medical University. According to the inclusion criteria, sixty-eight cases were divided into two groups according to the different ways of stoma: single lumen group (31 cases) and double lumen group (37 cases). We collected the basic clinical data of the two groups and the short-term results of the LAR+PI and the operation of ileostomy reversal. The endoscopic changes (edema, bleeding or contact bleeding) and the related clinical symptoms (serous/mucus/blood secretion, abdominal pain, tenesmus, diarrhea) 3~4 months later after the ostomy and 4~6 months later after the ileostomy reversal were collected.

Results

The preoperative data of the two groups were comparable, except that the operation time of double lumen group was shorter than that of single lumen group (50.00±7.55 min vs. 63.22±6.26 min,t=7.768;P<0.01). There was no statistical significance in the operation time, ileostomy reversal time, intraoperative bleeding volume, intestinal function recovery time, hospitalization time and recent postoperative complications of the two groups; The incidence rate of diversion colitis in the double lumen group was significantly lower than that in the single lumen group (54.1% vs. 80.6%, χ2=5.328; P<0.05). There was a significant difference in severity of diversion colitis between the two groups (16.2% vs. 51.6%, χ2=9.656; P<0.05). The incidence rate of diarrhea in the single lumen group was higher than that in the double lumen group (29.0% vs. 8.1%, χ2=5.082; P<0.05).

Conclusions

Both single lumen and double lumen ileostomy are safe and feasible. Double lumen ileostomy may have more advantages in preventing the occurrence and improving the outcome of diversion colitis.

表1 两组患者临床基本资料对比
图1 预防性回肠双腔造口术中步骤。1A:选定肠管造口位置;1B:修剪系膜;1C:穿入缝线;1D:将选定位置的肠管提出肠外,并间断缝合;1E:纵行切开肠管;1F:双腔造口完成
图2 预防性回肠单腔造口术中步骤。2A:选定肠管造口位置;2B:修剪系膜,选定切割位置;2C:直线切割闭合器切断回肠;2D:近端回肠提出腹壁;2E:间断缝合回肠于腹壁;2F:纵行切开肠管,单腔造口完成
图3 内镜下评分。3A~3C:黏膜出血(3A:1分;3B:2分;3C:3分);3D~3F:水肿(3D:1分;3E:2分;3F:3分)
图4 造口相关并发症。4A:造口水肿;4B:造口周围皮炎;4C:皮肤黏膜分离
表2 两组患者LAR+PI手术情况及术后短期疗效的比较
表3 两组患者造口还纳手术情况及术后短期疗效的比较
表4 造口还纳前DC发病率及其相关症状的比较[例(%)]
表5 造口还纳后DC患病率及其相关症状的比较[例(%)]
图5 消化道碘油造影。5A:口服碘油后30分钟;5B:口服碘油后2小时
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