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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2021, Vol. 10 ›› Issue (03) : 327 -331. doi: 10.3877/cma.j.issn.2095-3224.2021.03.019

护理天地

经临时性襻式回肠造口行远端灌洗对还纳术后患者肠功能恢复影响的回顾性队列研究
吕桂芬1, 戴莉莉2, 方瑞华2, 周欢2, 朱灵芝2, 赵子夜2, 于恩达2, 李淑英3,†()   
  1. 1. 200120　同济大学医学院　上海市东方医院普外科肛肠外科
    2. 200433　海军军医大学第一附属医院（上海长海医院）肛肠外科
    3. 200433　海军军医大学第一附属医院（上海长海医院）康复科
  • 收稿日期:2020-09-05 出版日期:2021-06-25
  • 通信作者: 李淑英
  • 基金资助:
    国家重点研发计划(2017YFC1308800); 国家自然科学基金面上项目(81870455); 上海长海医院234学科攀峰计划(2019YXK036)

Effect of anterograde lavage via temporary loop ileostomy on the recovery of bowel function in patients receiving stoma closure: a retrospective cohort study

Guifen Lyu1, Lili Dai2, Ruihua Fang2, Huan Zhou2, Lingzhi Zhu2, Ziye Zhao2, Enda Yu2, Shuying Li3,†()   

  1. 1. Department of General Surgery and Colorectal Surgery, Shanghai East Hospital, Tongji University of Medicine, Shanghai 200120, China
    2. Department of Anal Surgery
    3. Department of Rehabilitation, First Hospital Affiliated to Naval Medical University (Changhai Hospital), Shanghai 200433, China
  • Received:2020-09-05 Published:2021-06-25
  • Corresponding author: Shuying Li
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吕桂芬, 戴莉莉, 方瑞华, 周欢, 朱灵芝, 赵子夜, 于恩达, 李淑英. 经临时性襻式回肠造口行远端灌洗对还纳术后患者肠功能恢复影响的回顾性队列研究[J]. 中华结直肠疾病电子杂志, 2021, 10(03): 327-331.

Guifen Lyu, Lili Dai, Ruihua Fang, Huan Zhou, Lingzhi Zhu, Ziye Zhao, Enda Yu, Shuying Li. Effect of anterograde lavage via temporary loop ileostomy on the recovery of bowel function in patients receiving stoma closure: a retrospective cohort study[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2021, 10(03): 327-331.

目的

探讨襻式回肠造口患者还纳术前进行造口远端灌洗对围手术期肠功能恢复的影响。

方法

选取2019年3月至2019年8月间上海长海医院肛肠外科连续收治的行造口还纳术的直肠癌术后患者，根据是否接受造口远端灌洗分为灌洗组和非灌洗组，搜集患者一般资料及围手术期信息（排气、排便、进食、住院时间等）并行组间比较。

结果

共133例符合条件的病例纳入分析，其中灌洗组68例、非灌洗组65例。组间年龄、性别比例、吻合口锯齿线距离差异均无统计学意义。灌洗组术后排气时间（t=2.544，P＜0.05）、排便时间（t=3.864，P＜0.05）、进食时间（t=3.409，P＜0.05）、住院时间（t=4.695，P＜0.05）均显著短于非灌洗组，住院总费用显著低于非灌洗组（t=2.254，P＜0.05）。两组术后肠梗阻发生率差异无统计学意义（χ2=1.056，P＞0.05）。

结论

襻式回肠造口还纳术前行远端灌洗有助于患者肠功能恢复，降低患者住院时间及经济成本，适宜推广应用。

关键词: 直肠肿瘤, 肠梗阻, 襻式肠造口, 灌洗术
Objective

To investigate the effect of anterograde lavage via temporary loop ileostomy on perioperative bowel function recovery in patients receiving stoma closure.

Methods

The candidates were rectal cancer patients who had received anterior resection and planned to receive stoma closure in Department of Colorectal Surgery, Changhai Hospital during March and August 2019. The enrolled patients were divided into two groups according to whether they received anterograde lavage before stoma closure. General data and perioperative information (exhaust time, defecation time, recovery time of meal, hospitalization time, etc.) were collected and compared between groups.

Results

A total of 133 eligible cases were included in the analysis, including 68 in the lavage group and 65 in the non-lavage group. There were no statistically significant differences in age, gender ratio, and distance between the anastomotic line and dental line. In the lavage group, patients' postoperative exhaust time (t=2.544, P＜0.05), defecation time (t=3.864, P＜0.05), recovery time of meal (t=3.409, P＜0.05) and hospitalization time (t=4.695, P＜0.05) were significantly shorter than those in the non-lavage group, and the total cost was significantly lower than that of the non-lavage group (t=2.254, P＜0.05). There was no significant difference in the incidence of postoperative intestinal obstruction rate between the two groups(χ2=1.056,P＞0.05).

Conclusion

Anterograde lavage before stoma closure can help patients recover their bowel function, reduce time and economic cost of the patients, which is conforms to the concept of enhanced recovery after surgery, and is suitable for popularization and application.

Key words: Rectal neoplasms, Intestinal obstruction, Loop ileostomy, Lavage
图1 灌洗装置（右上 组装前）
表1 灌洗组及非灌洗组的观察指标比较
变量 非灌洗组（n=65） 灌洗组（n=68） 统计值* P值
年龄（岁） 58.88±11.78 58.22±11.97 0.319 0.751
性别（男/女） 39/26 42/26 0.043 0.835
齿线距离（cm） 3.29±0.70 3.56±0.94 -1.863 0.065
排气时间（h） 45.00±12.11 40.13±9.89 2.544 0.012
排便时间（h） 54.32±13.20 45.96±11.76 3.864 ＜0.001
进食时间（h） 68.32±28.57 54.31±17.18 3.409 0.001
总住院天数（d） 7.45±2.38 5.71±1.87 4.695 ＜0.001
住院总费用（万元） 3.12±0.69 2.86±0.62 2.254 0.026
肠梗阻（例） 7（10.8%） 4（5.9%） 1.056 0.358
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