CAJ | 학술논문

目的探讨自闭性回肠插管造口在低位直肠癌新辅助放化疗后保肛手术预防吻合口漏的安全性和可行性.方法收集2010-2013年浙江省德清县人民医院和浙江大学附属第一医院肛肠外科收治的54例中低位直肠癌新辅助放化疗后保肛手术患者的临床资料.54例随机分为两组,A组为自闭性回肠插管造口术28例,B组为传统回肠襻式造口术26例,观察两组患者术后并发症、安全性和经济、社会性等方面的意义.结果两组回肠造口方式均对直肠吻合口有保护作用,其中A组保护时间平均为21(15 ～35)d,造口导管拔除后造口自动闭合(愈合)的成功率为100％;B组患者术后3～6个月再次行造口回纳术,术后出现严重并发症1例.两组术后均未出现明显的吻合口漏.结论在中低位直肠癌新辅助放化疗后自闭性回肠插管造口术能够起到和传统回肠造口术相同的预防吻合漏的作用,且安全性高,医疗费用低,能有效避免再次造口回纳术给患者带来的创伤和经济负担.
목적 탐토자폐성회장삽관조구재저위직장암신보조방화료후보항수술예방문합구루적안전성화가행성.방법 수집2010-2013년절강성덕청현인민의원화절강대학부속제일의원항장외과수치적54례중저위직장암신보조방화료후보항수술환자적림상자료.54례수궤분위량조,A조위자폐성회장삽관조구술28례,B조위전통회장반식조구술26례,관찰량조환자술후병발증、안전성화경제、사회성등방면적의의.결과 량조회장조구방식균대직장문합구유보호작용,기중A조보호시간평균위21(15 ～35)d,조구도관발제후조구자동폐합(유합)적성공솔위100％;B조환자술후3～6개월재차행조구회납술,술후출현엄중병발증1례.량조술후균미출현명현적문합구루.결론 재중저위직장암신보조방화료후자폐성회장삽관조구술능구기도화전통회장조구술상동적예방문합루적작용,차안전성고,의료비용저,능유효피면재차조구회납술급환자대래적창상화경제부담.
Objective To explore the safety and applicability of a temporary protective ileostomy that closes itself in the prevention of anastomotic leakage following anterior resection after chemoradiation for rectal cancer.Methods From Oct 2010 to Oct 2013,54 cases of middle or low rectal carcinoma were admitted.Protective ileostomy was created to prevent anastomotic leakage.Patients were divided into two groups receiving respectively intubation ileostomy (group A,28 cases),and conventional ileostomy (group B,26 cases).Results The mean time for anus to restore defecation was identical in the two groups.The period of protection of the anastomosis,was 21 d (15 ～ 35 d) in group A.The rate of spontaneous closure of the stoma after removal of the tube was 100％.The stoma was reduced after 3 to 6 months in group B and major complication developed in one case in this group.Conclusions Temporary ileostomy prevents anastomotic leakage of anterior resection in patients of rectal carcinoma receiving preoperative neoadjuvant chemoradiotherapy.Intubation ileostomy is effective and safe in prevention of anastomotic leakage saving stoma reduction procedures.