简易支撑架联合一针缝合法在直肠癌末端回肠造口中的应用

doi:10.16139/j.1007-9610.2023.01.13

摘要/Abstract

摘要：

目的：探讨低位直肠癌病人保肛根治手术中，应用简易支撑架联合一针缝合行末端回肠双腔造口的可行性及效果。方法回顾性分析2019年12月至2021年5月我院普外科有术后吻合口漏高危因素的直肠癌病人。病人行腹腔镜辅助低位直肠癌根治术和末端回肠双腔造口术。分为简易支撑架联合一针缝合造口组35例，传统缝合造口组35例。术前、术后资料行统计学分析。结果： 两组病人一般资料及术后造口相关并发症发生率差异无统计学意义(P>0.05)。所有病人住院期间均未出现严重并发症。所有病人末端回肠造口均成功还纳。简易支撑架联合一针缝合造口组病人一期造口时间[(13.77±2.02) min比(22.66±3.64)min（P<0.001）]；二期造口还纳时间[(88.14±28.03) min比(103.29±30.96) min（P=0.04）]和术后总住院时间[(14.54±2.32) d比(17.34±4.57) d（P=0.002)]；以及一期手术住院费用[(42 057.98±4 938.69)元比(44 728.46±5 223.62)元，（P=0.03）]和二期造口还纳手术出血量[(17.94±9.83) mL比(25.86±8.24) mL(P=0.001)]均少于传统缝合造口组，差异具有统计学意义。结论：相比传统缝合造口，简易支撑架联合一针缝合造口术后造口相关并发症并未增加，但造口手术时间和二期还纳时间缩短，住院费用减少，可用于低位直肠癌的预防性造口手术。

关键词: 直肠癌, 造口, 简易支撑架, 一针缝合法

Abstract:

Objective To investigate the feasibility and effect of simple support bracket combined with one stitch suture in terminal ileostomy of two stomas during anus-preserving radical resection in low rectal cancer patients. Methods Retrospectively analysis was performed for rectal cancer patients with high risk factors for postoperative anastomotic leakage, who admitted to the Department of General Surgery our hospital from December 2019 to May 2021. The patients underwent laparoscopic-assisted low rectal cancer radical resection and terminal ileostomy. There were two groups including 35 patients in the group of simple bracket combined with one stitch suture, and 35 patients in the group of conventional suture. Preoperative and postoperative clinical data were analyzed. Results General data of two groups were similar. No difference statistical significantly in the rate of postoperative stoma‐related complications between the two groups ((P>0.05). All patients were without any severe complications. All stomas were successfully closed. The time of first-stage ileostomy (13.77±2.02) min vs. (22.66±3.64) min (P<0.001), second-stage stoma closure time (88.14±28.03) min vs. (103.29±30.96) min (P=0.04), and postoperative total time in hospital (14.54±2.32) d vs. (17.34±4.57) d (P=0.002) were shorter in simple bracket combined with one stitch suture group; both total cost in the hospital of first-stage operation (42 057.98±4 938.69) yuan vs. (44 728.46±5 223.62) yuan (P=0.03), and second-stage stoma closure blood loss (17.94±9.83) mL vs. (25.86±8.24) mL (P=0.001) lower compared with that in conventional suture group. Conclusions Simple support bracket combined with one stitch suture ileostomy did not increase postoperative stoma-related complications compared with conventional suture. However, it decreased the time for both first-stage ileostomy and second-stage stoma closure, and total cost in hospital. Therefore, it could be used for prophylactic ileostomy in low rectal cancer.

Key words: Rectal cancer, Stoma, Simple support bracket, One stitch suture

中图分类号:

R735.37

胡磊, 许亚龙, 刘少军, 何义仁, 刘流, 朱志强. 简易支撑架联合一针缝合法在直肠癌末端回肠造口中的应用[J]. 外科理论与实践, 2023, 28(01): 77-82.

HU Lei, XU Yalong, LIU Shaojun, HE Yiren, LIU Liu, ZHU Zhiqiang. Application of simple support bracket combined with one stitch suture in terminal ileostomy of rectal cancer[J]. Journal of Surgery Concepts & Practice, 2023, 28(01): 77-82.

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Item	Control group	Study group	χ² value	P value
Age(year)
≥60	25(71.4%)	22(62.9%)	0.58	0.46
<60	10(28.6%)	13(37.1%)
Gender
Male	26(74.3%)	24(68.6%)	0.28	0.60
Female	9(25.7%)	11(31.4%)
Cardiovascular disease
Yes	12(34.3%)	11(31.4%)	0.06	0.80
No	23(65.7%)	24(68.6%)
Diabetes
Yes	4(11.4%)	1(2.9%)	1.94	0.16
No	31(88.6%)	34(97.1%)
TNM stage
Ⅰ	15(42.9%)	12(34.3%)
Ⅱ	13(37.1%)	18(51.4%)	1.47	0.48
Ⅲ	7(20.0%)	5(14.3%)

Item	Control group	Study group	t value	P value
First-stage operative time (min)	202.14±45.70	183.57±34.67	1.91	0.06
First-stage operative blood loss (mL)	59.03±11.49	54.11±10.30	1.88	0.06
First-stage ileostomy time(min)	22.66±3.64	13.77±2.02	3.22	<0.001
First-stage ileostomy blood loss (mL)	4.54±1.80	3.80±1.83	1.71	0.09
Postoperative stoma exhaust time (d)	2.63±0.49	2.37±0.69	1.80	0.08
First-stage total cost in hospital stay(Yuan)	44 728.46±5 223.62	42 057.98±4 938.69	2.20	0.03
Second-stage stoma closure time (min)	103.29±30.96	88.14±28.03	2.15	0.04
Second-stage stoma closure blood loss (mL)	25.86±8.24	17.94±9.83	3.65	0.001
First and second-stage total days in hospital stay (d)	17.34±4.57	14.54±2.32	3.23	0.002

Complication	Control group	Study group	χ² value	P value
Fecal dermatitis	4(11.4%)	3(8.6%)
Parastomal hernia	2(5.7%)	1(2.9%)
Stoma ischemia	2(5.7%)	0
Total	8(22.9%)	4(11.4%)	1.61	0.21