[1]冯海龙邢林帅薛明媚许召君王高翔韦婧昊赫鹏**.腹腔镜辅助回肠造口还纳与开放手术的比较【Key Words】ry[J].中国微创外科杂志,2025,01(9):539-544.
　Feng Hailong,Xing Linshuai,Xue Mingmei,et al.A Comparitive Study Between Laparoscopic Assisted Ileostomy Closure and Open Surgery[J].Chinese Journal of Minimally Invasive Surgery,2025,01(9):539-544.
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腹腔镜辅助回肠造口还纳与开放手术的比较【Key Words】ry()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2025年9期
页码:
539-544
栏目:
临床研究
出版日期:
2025-09-25

文章信息/Info

Title:
A Comparitive Study Between Laparoscopic Assisted Ileostomy Closure and Open Surgery
作者:
冯海龙邢林帅薛明媚许召君王高翔韦婧昊赫鹏**
(新乡医学院第一附属医院结直肠外科，卫辉453100)
Author(s):
Feng Hailong;  Xing Linshuai;  Xue Mingmei;  et al.
Department of Colorectal Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
关键词:
直肠癌; 腹腔镜辅助手术; 回肠造口还纳术; 经自然腔道取标本手术
Keywords:
Rectal cancer; Laparoscopic assisted surgery; Ileostomy closure; Natural orifice specimen extraction surge
文献标志码:
A
摘要:
目的探讨预防性回肠造口后腹腔镜辅助回肠造口还纳术的应用价值。方法回顾性分析2017年9月~2023年5月我院63例中低位直肠癌经自然腔道取标本手术(natural orifice specimen extraction surgery，NOSES)预防性回肠造口的造口还纳术资料，行腹腔镜辅助回肠造口还纳术31例(观察组)，常规开放回肠造口还纳术32例(对照组)，比较2组造口还纳手术时间、术中出血量、术后首次下床时间、术后首次排气时间、术后首次进流食时间、术后疼痛评分、术后住院时间和术后并发症。结果63例均顺利完成回肠造口还纳手术。观察组手术时间［(63.2±5.7)min vs.(93.5±4.7)min，t=-23.109，P=0.000］，术中出血量［7.0(6.0，8.0)ml vs. 22.5(21.0，24.0)ml，Z=-6.853，P=0.000］，术后下床时间［1.0(1.0，1.0)d vs. 2.0(2.0，2.0)d，Z=-5.653，P=0.000］，术后排气时间［1.0(1.0，2.0)d vs. 2.0(2.0，2.0)d，Z=-5.304，P=0.000］，术后进流食时间［2.0(2.0，3.0)d vs. 3.0(2.0，3.0)d，Z=-3.000，P＝0.003］，术后疼痛评分［24 h：3.0(3.0，4.0)分vs.4.0(3.0，4.0)分，Z=-4.501，P=0.000；48 h：2.0(2.0，2.0)分vs.3.0(2.0，3.0)分，Z=-3.750，P=0000；72 h：1.0(1.0，2.0)分vs.2.0(2.0，2.0)分，Z=-2.996，P=0.003］，术后住院时间［(6.8±1.6)d vs. (8.5±1.5)d，t=-4.297，P=0.000］均优于对照组(P<0.05)。观察组术后切口感染率低于对照组［3.2%(1/31) vs.34.4%(11/32), χ2=9.908，P=0.002］，2组术后切口裂开、肠梗阻及腹腔出血率差异无显著性(P>0.05)。结论中低位直肠癌NOSES预防性回肠造口术后行回肠造口还纳术时，应用腹腔镜辅助回肠造口还纳术安全、可行，较开放手术可降低切口感染率，减轻切口疼痛，缩短住院时间，促进术后恢复。
Abstract:
ObjectiveTo explore the application value of laparoscopic assisted ileostomy closure after prophylactic ileostomy.MethodsA retrospective analysis was conducted on 63 cases of middle and low rectal cancer who received ileostomy closure after prophylactic ileostomy in natural orifice specimen extraction surgery (NOSES) from September 2017 to May 2023. Among them, 31 cases underwent laparoscopic assisted ileostomy closure (observation group), and 32 cases underwent conventional open ileostomy closure (control group). The operative time, intraoperative blood loss, time to first ambulation, time to first flatus, time to first liquid diet, postoperative pain score, postoperative hospital stay time, and postoperative complications were compared between the two groups.ResultsAll the 63 cases successfully underwent ileostomy closure. The observation group showed significantly better outcomes than the control group in operative time ［(63.2±5.7) min vs. (93.5±4.7) min, t=-23.109, P=0.000］, intraoperative blood loss ［7.0 (6.0, 8.0) ml vs. 22.5 (21.0, 24.0) ml, Z=-6.853, P=0.000］, time to first ambulation ［1.0 (1.0, 1.0) d vs. 2.0 (2.0, 2.0) d, Z=-5.653, P=0.000］, time to first flatus ［1.0 (1.0, 2.0) d vs. 2.0 (2.0, 2.0) d, Z=-5.304, P=0000］, time to first liquid diet ［2.0 (2.0, 3.0) d vs. 3.0 (2.0, 3.0) d, Z=-3.000, P=0.003］, postoperative pain score ［24 h: 3.0 (3.0, 4.0) vs. 4.0 (3.0, 4.0), Z=-4.501, P=0.000; 48 h: 2.0 (2.0, 2.0) vs. 3.0 (2.0, 3.0), Z=-3.750, P=0.000; 72 h: 1.0 (1.0, 2.0) vs. 2.0 (2.0, 2.0), Z=-2.996, P=0.003］, and postoperative hospital stay ［(6.8±1.6) d vs. (8.5±1.5) d, t=-4.297, P=0.000］. The observation group had a lower postoperative incision infection rate than the control group ［3.2% (1/31) vs. 34.4% (11/32), χ2=9.908, P=0.002］, while no significant differences were observed in incision dehiscence, intestinal obstruction, or abdominal hemorrhage (P>0.05).ConclusionsFor patients with middle and low rectal cancer who undergoing ileostomy closure after prophylactic ileostomy in NOSES, laparoscopic assisted ileostomy closure is safe and feasible. Compared with open surgery, it reduces incision infection rate, alleviates postoperative pain, shortens hospital stay, and promotes recovery.

参考文献/References:

[1]Guan X,Hu X,Jiang Z,et al.Shortterm and oncological outcomes of natural orifice specimen extraction surgery (NOSES) for colorectal cancer in China:a national database study of 5055 patients.Sci Bull (Beijing),2022,67(13):1331-1334.
[2]楼征,张卫.中国直肠癌手术吻合口漏诊断预防及处理专家共识2019版解读.临床外科杂志,2020,28(1):41-42.
[3]Gachabayov M,Lee H,Chudner A,et al.Pursestring vs.linear skin closure at loop ileostomy reversal:a systematic review and metaanalysis.Tech Coloproctol,2019,23(3):207-220.
[4]Sebastian A,Stupart D,Watters DA.Loop ileostomy reversal after laparoscopic versus open rectal resection.ANZ J Surg,2019,89(3):E52-E55.
[5]Royds J,O’Riordan JM,Mansour E,et al.Randomized clinical trial of the benefit of laparoscopy with closure of loop ileostomy.Br J Surg,2013,100(10):1295-1301.
[6]Russek K,George JM,Zafar N,et al.Laparoscopic loop ileostomy reversal:reducing morbidity while improving functional outcomes.JSLS,2011,15(4):475-479.
[7]Copescu C,Smeu B,Catanescu E,et al.Early laparoscopic ileostomy reversal after rectal cancer surgery:technique and outcomes.Chirurgia (Bucur),2019,114(3):392-400.
[8]罗寿,苏昊,徐正,等.完全腹腔镜与传统开放回肠袢式造口还纳术的疗效对比研究.中华结直肠疾病电子杂志,2021,10(4):357-361.
[9]冯海龙,邢林帅,雒红涛,等.改良预防性回肠造口术在中低位直肠癌经自然腔道取标本手术中的应用.中国微创外科杂志,2024,24(9):617-622.
[10]黎淑玲,罗劲根,刘俊杰.十字缝合法在肠造口回纳中的应用.临床外科杂志,2022,30(4):357-359.
[11]段玉霞,房志学,张玲.肠造口还纳术后切口感染的研究进展.结直肠肛门外科,2023,29(6):627-631.
[12]Lim JT,Shedda SM,Hayes IP.“Gunsight” skin incision and closure technique for stoma reversal.Dis Colon Rectum,2010,53(11):1569-1575.

备注/Memo

备注/Memo:
基金项目：河南省医学科技攻关计划项目(HLGJ20200526)**通讯作者，Email：hepeng163001@163.com
更新日期/Last Update: 2025-10-17