The advantages and disadvantages of protective ileostomy in low rectal cancer surgery

doi:10.3877/cma.j.issn.2095-3224.2015.01.20

Abstract

Key words: Low rectal cancer, Anus-preserving surgery, Protective ileostomy, Anastomotic leakage

Hong-hu WANG, Hao XU, Zhen-ning WANG, Hui-mian XU. The advantages and disadvantages of protective ileostomy in low rectal cancer surgery[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2015, 04(01): 78-80.

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Figures/Tables 3

References 15

[1]	陈平．低位直肠癌保肛术后肿瘤复发的治疗．中华胃肠外科杂志，2010，3：225-226.
[2]	蔡三军．结直肠肛管癌．北京：北京大学医学出版社，2006：266-270.
[3]	Richardson DL, Mariani A, Cliby WA.Risk factors for anastomotic leak after recto-sigmoid resection for ovarian cancer.Gynecol Oncol，2006，103(2)：667-672.
[4]	Gastinger I, Marusch F, Steinert R，et al.Protective defunctioning stoma in low anterior resection for rectal carcinoma.Br J Surg，2005，92(9)：1137-1142.
[5]	Giuliani D, Willemsen P, Van Elst F，et al.A defunctioning stoma in the treatment of lower third rectal carcinoma.Acta Chir Belg，2006，106(1)：40-43.
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[8]	黄志强．外科手术学．北京：人民卫生出版社，2005：797-798.
[9]	陈杰，王森，王道荣，等．结直肠吻合术后预防性回肠造口与结肠造口比较的Meta分析，国际外科学杂志，2012，39(8)：539-545.
[10]	王道荣，李清国，汤东，等．腹腔镜低位和超低位直肠癌保肛根治术中改良襻式回肠末端造瘘的应用价值，中华消化外科杂志，2013，12(5)：362-365.
[11]	Thoker M, Wani I, Parray FQ，et al.Role of diversion ileostomy in low rectal cancer：a randomized controlled trial.International Journal of Surgery，2014，12：945-951.
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[15]	崔伟，左富义，陈纲．预防性末端回肠造瘘对低位直肠癌保肛患者术后营养和功能状态的影响．临床军医杂志，2012，40(4)：853-855.

比较项目		患者例数
性别		?
?	男	64
?	女	43
年龄		?
?	≤60岁	48
?	>60岁	59
分化程度		?
?	高分化	52
?	中分化	43
?	低分化	12
大体分型		?
?	溃疡型	77
?	浸润型	30
组织学分型		?
?	管状腺癌	48
?	乳头状腺癌	32
?	绒毛状腺癌	27
肿瘤下缘距肛缘		?
?	6～8 cm	58
?	<6 cm	49
术前情况		?
?	合并肠梗阻或不全肠梗阻	59
?	接受新辅助放化疗	39
?	合并基础疾病	31
?	合并中重度贫血或营养不良	57
?	术前评估拟术后入ICU	24

比较项目		患者例数
性别		?
?	男	64
?	女	43
年龄		?
?	≤60岁	48
?	>60岁	59
分化程度		?
?	高分化	52
?	中分化	43
?	低分化	12
大体分型		?
?	溃疡型	77
?	浸润型	30
组织学分型		?
?	管状腺癌	48
?	乳头状腺癌	32
?	绒毛状腺癌	27
肿瘤下缘距肛缘		?
?	6～8 cm	58
?	<6 cm	49
术前情况		?
?	合并肠梗阻或不全肠梗阻	59
?	接受新辅助放化疗	39
?	合并基础疾病	31
?	合并中重度贫血或营养不良	57
?	术前评估拟术后入ICU	24

术后一般情况	时间(d)
经肛排气时间	2.1±0.4
经口进全流食时间	2.2±0.3
拔出骶前引流管时间	8.2±2.6
术后住院时间	9.7±2.5

术后一般情况	时间(d)
经肛排气时间	2.1±0.4
经口进全流食时间	2.2±0.3
拔出骶前引流管时间	8.2±2.6
术后住院时间	9.7±2.5

术后情况	例数	所占总例数百分比(%)
死亡	0	0
入ICU重症监护	27	25.23
吻合口漏	2	1.87
重度腹泻，电解质紊乱	17	15.89
造瘘口小肠近端狭窄，梗阻	7	6.54
废用性肠炎	11	10.28
切口感染	6	5.61
直肠吻合口狭窄	37	34.58
再次出现吻合口漏	1	0.93
行还瘘手术	91	85.05
未/不适宜还瘘手术	16	14.95

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