中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2010年
19期
1479-1483
,共5页
左志贵%宋华羽%徐昶%李激%倪士昌%周振华%陈绍棋
左誌貴%宋華羽%徐昶%李激%倪士昌%週振華%陳紹棋
좌지귀%송화우%서창%리격%예사창%주진화%진소기
直肠肿瘤%内括约肌切除术%保护性造口
直腸腫瘤%內括約肌切除術%保護性造口
직장종류%내괄약기절제술%보호성조구
Rectal neoplasms%Intersphincteric resection%Protective stoma
目的 探讨保护性造口在超低位直肠肿瘤内括约肌切除术(ISR)中的应用价值.方法 对1999年1月至2009年7月给予经肛ISR联合经腹全直肠系膜切除术结肠肛管吻合术的56例无肛门外括约肌受侵的超低位直肠肿瘤患者的临床资料进行回顾性分析,比较造口组(16例)与未造口组(40例)患者术后吻合口和肛门部并发症及肛门功能恢复情况.结果 56例患者中16例(28.6%)行保护性造口.未造口组术后吻合口和肛门部并发症分别出现14例(35.0%)和16例(40.0%),而造口组吻合口及肛门部并发症分别仅出现1例(1/16),两组差异有统计学意义(P<0.05).未造口组1例吻合口裂开肿瘤复发再手术行永久性结肠造口,另3例吻合口及肛门病变需造口及二期手术治疗,再手术率为10.0%.两组患者术后肛门控便能力均下降,造口组患者造口回纳术后3、6、12个月肛门功能Kirwan评分达Ⅰ级者分别为11/16、13/15、11/13,未造口组患者术后3、6、12个月达Ⅰ级比例分别为30.0%、37.5%、45.0%,术后同期造口组患者肛门功能均明显优于未造口组患者(P<0.05).结论 保护性肠造口可减少超低位直肠肿瘤ISR后吻合口瘘,消除术后早期肛门失禁给患者带来的痛苦,且有利于肛门功能的恢复.
目的 探討保護性造口在超低位直腸腫瘤內括約肌切除術(ISR)中的應用價值.方法 對1999年1月至2009年7月給予經肛ISR聯閤經腹全直腸繫膜切除術結腸肛管吻閤術的56例無肛門外括約肌受侵的超低位直腸腫瘤患者的臨床資料進行迴顧性分析,比較造口組(16例)與未造口組(40例)患者術後吻閤口和肛門部併髮癥及肛門功能恢複情況.結果 56例患者中16例(28.6%)行保護性造口.未造口組術後吻閤口和肛門部併髮癥分彆齣現14例(35.0%)和16例(40.0%),而造口組吻閤口及肛門部併髮癥分彆僅齣現1例(1/16),兩組差異有統計學意義(P<0.05).未造口組1例吻閤口裂開腫瘤複髮再手術行永久性結腸造口,另3例吻閤口及肛門病變需造口及二期手術治療,再手術率為10.0%.兩組患者術後肛門控便能力均下降,造口組患者造口迴納術後3、6、12箇月肛門功能Kirwan評分達Ⅰ級者分彆為11/16、13/15、11/13,未造口組患者術後3、6、12箇月達Ⅰ級比例分彆為30.0%、37.5%、45.0%,術後同期造口組患者肛門功能均明顯優于未造口組患者(P<0.05).結論 保護性腸造口可減少超低位直腸腫瘤ISR後吻閤口瘺,消除術後早期肛門失禁給患者帶來的痛苦,且有利于肛門功能的恢複.
목적 탐토보호성조구재초저위직장종류내괄약기절제술(ISR)중적응용개치.방법 대1999년1월지2009년7월급여경항ISR연합경복전직장계막절제술결장항관문합술적56례무항문외괄약기수침적초저위직장종류환자적림상자료진행회고성분석,비교조구조(16례)여미조구조(40례)환자술후문합구화항문부병발증급항문공능회복정황.결과 56례환자중16례(28.6%)행보호성조구.미조구조술후문합구화항문부병발증분별출현14례(35.0%)화16례(40.0%),이조구조문합구급항문부병발증분별부출현1례(1/16),량조차이유통계학의의(P<0.05).미조구조1례문합구렬개종류복발재수술행영구성결장조구,령3례문합구급항문병변수조구급이기수술치료,재수술솔위10.0%.량조환자술후항문공편능력균하강,조구조환자조구회납술후3、6、12개월항문공능Kirwan평분체Ⅰ급자분별위11/16、13/15、11/13,미조구조환자술후3、6、12개월체Ⅰ급비례분별위30.0%、37.5%、45.0%,술후동기조구조환자항문공능균명현우우미조구조환자(P<0.05).결론 보호성장조구가감소초저위직장종류ISR후문합구루,소제술후조기항문실금급환자대래적통고,차유리우항문공능적회복.
Objective To investigate the value of protective stoma in intersphincteric resection (ISR)for ultra-low rectal cancer. Methods Clinical data of 56 ultra-low rectal cancer patients without involvement of external anal sphincter treated during January 1999 to July 2009 with trans-anal ISR plus trans-abdominal total mesorectum excision and coloanal anastomosis were retrospectively analyzed. The patients were divided into two groups based on whether they received protective ostomy: ostomy group (16 cases)and ostomy-frec group(40 cases). The postoperative complications as well as anal functional restoration were compared between the two groups. Results Sixteen cases (32. 1%)of the 56 patients received protective stoma. The complication rate of anastomosis and anus complication rate in the ostomy-free group were significantly higher than those in ostomy group [35.0% (14/40)and 40. 0% (16/40)vs. 1/16 and 1/16;P <0. 05]. In the ostomy-free group, one patient developed anastomotic dehiscence and tumor recurrence, the patients was given permanent colostomy, and the other three patients with lesions in the anastomosis and anus received ostomy and secondary surgical treatment, with a reoperation rate of 10. 0%(4/40). The anal function of patients in the two groups were both decreased after the operation. The rate of patients got Kirwan grade Ⅰ anal sphincter function in the 3rd, 6th and 12th month after protective stoma operation was 11/16, 13/15 and 11/13 in the ostomy group, respectively; and those were 30. 0%, 37.5% and 45. 0% in the ostomy-free group, respectively. Anal function was significantly better in the ostomy group than that in the ostomy-free group during the same postoperative period(P<0.05). Conclusion Protective stoma can avoid anastomotic leakage following ISR for ultra-low rectal cancer, and alleviate the suffering of anal incontinence in the early postoperative period, and is conducive to the restoration of anal function.