[1]岳晔玮① 张志宇 毛晓俊 马彭**②.12 mm trocar在腹腔镜低位直肠癌根治术后预防性回肠造口中的应用[J].中国微创外科杂志,2022,01(11):869-873.
　Yue Yewei,Zhang Zhiyu*,Mao Xiaojun*,et al.Application of 12 mm Trocar in Prophylatic Ileostomy After Laparoscopic Radical Resection for Low Rectal Cancer[J].Chinese Journal of Minimally Invasive Surgery,2022,01(11):869-873.
点击复制

12 mm trocar在腹腔镜低位直肠癌根治术后预防性回肠造口中的应用()
分享到：

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

卷:
01
期数:
2022年11期
页码:
869-873
栏目:
临床研究
出版日期:
2023-02-23

文章信息/Info

Title:
Application of 12 mm Trocar in Prophylatic Ileostomy After Laparoscopic Radical Resection for Low Rectal Cancer
作者:
岳晔玮① 张志宇 毛晓俊 马彭**②
(南通大学附属丹阳医院胃肠外科，丹阳212300)
Author(s):
Yue Yewei;  Zhang Zhiyu*;  Mao Xiaojun*;  et al.
*Department of Gastrointestinal Surgery, Affiliated Danyang Hospital of Nantong University, Danyang 212300, China
关键词:
低位直肠癌; 预防性回肠造口
Keywords:
Low rectal cancer; Prophylatic ileostomy
文献标志码:
A
摘要:
目的探讨12 mm trocar在腹腔镜低位直肠癌根治术后预防性回肠造口中的临床应用效果。方法回顾性分析2014年3月～2021年12月我院60例低位直肠癌的临床资料，2018年1月～2021年12月30例应用12 mm trocar行预防性回肠造口为观察组，2014年3月～2017年12月30例常规造口为对照组，观察2组患者造口手术时间、造口手术出血量、术后24 h 造口处疼痛数字评分(Numeric Rating Scale，NRS)、造口相关并发症发生率、住院时间的差异。结果2组手术顺利，未发生严重并发症。观察组造口手术时间(19.5±3.8)min，显著短于对照组(25.7±5.8)min(t=-4.898，P=0.000)；造口手术出血量(14.2±4.4)ml，明显少于对照组(18.7±5.6)ml(t=-3.461，P=0.001)；术后24 h 造口处疼痛NRS(2.2±10)分，明显低于对照组(3.2±1.0)分(t=-3.873，P=0.000)。2组造口相关并发症发生率分别为6.7%(2/30)、13.3%(4/30)，差异无统计学意义(P=0.667)；住院时间分别为(9.6±1.1)d、(9.7±1.0)d，差异无统计学意义(t=-0.368，P=0714)。结论12 mm trocar应用在腹腔镜低位直肠癌根治术后预防性回肠造口中安全、可靠，值得临床推广应用。
Abstract:
ObjectiveTo observe the clinical efficacy of 12 mm trocar in the prophylactic ileostomy after laparoscopic radical resection for low rectal cancer.MethodsClinical data of 60 patients with low rectal cancer in our department from March 2014 to December 2021 were analyzed retrospectively. The 30 patients who underwent the prophylactic ileostomy with 12 mm trocar from January 2018 to December 2021 were admitted to the observation group, while the other 30 patients who underwent conventional ostomy from March 2014 to December 2017 were admitted to the control group. The indexes such as operation time of ostomy, intraoperative bleeding volume of ostomy, Numeric Rating Scale (NRS) of stoma pain 24 h after operation, the incidence of ileostomyrelated complications, and hospitalization time were compared.ResultsThe operations were successfully completed in both groups without serious complications. The operation time of ostomy was (19.5±3.8) min in the observation group and (25.7±5.8) min in the control group, which showed a significant difference (t=-4.898, P=0.000). The intraoperative bleeding volume of ostomy was (14.2±4.4) ml in the observation group and (18.7±5.6) ml in the control group, which showed a significant difference (t=-3.461, P=0.001). The NRS of stoma pain 24 h after operation was (2.2±1.0) points in the observation group and (3.2±1.0) points in the control group, which showed a significant difference (t=-3.873, P=0.000). There was no significant difference between the two groups in the incidence of ileostomyrelated complications ［6.7% (2/30) vs. 13.3% (4/30), P=0.667］, and the hospitalization time ［(9.6±1.1) d vs. (9.7±1.0) d, t=-0.368, P=0.714］.ConclusionsThe 12 mm trocar is safe and reliable in the application of prophylactic ileostomy after laparoscopic radical resection for low rectal cancer. It is worthy of popularization and application in clinical parctice.

参考文献/References:

[1]杨阳，魏东.低位直肠癌外科治疗新进展.国际外科学杂志,2015,42(5):356-360.
[2]方钱，徐洪根，马进，等.腹腔镜与开腹Dixon手术治疗直肠癌的比较.中国微创外科杂志,2019,19(7):600-602,613．
[3]Kruschewski M, Rieger H, Pohlen H, et al. Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer.Int J Colorectal Dis,2007,22:919-927.
[4]Eriksen MT, Wibe A, Norstein J, et al. The Norwegian Rectal Cancer Group. Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis,2005,7(1):51-57.
[5]Matthiessen P, Hallbk O, Andersson M, et al. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis,2004,6(6):462-469．
[6]杨卫华,高愫,张松柏.选择性预防末端回肠造瘘在腹腔镜低位直肠癌保肛手术中的应用价值.腹腔镜外科杂志,2014,19(7):509-511．
[7]肖燕玲,肖琴,张菊,等.不同造口术对低位直肠癌腹腔镜保肛手术患者预后的影响.实用癌症杂志,2020,35(8):1302-1305．
[8]中华医学会外科学分会腹腔镜与内镜外科学组,中华医学会外科学分会结直肠外科学组,中国医师协会外科医师分会结直肠外科医师委员会,等.腹腔镜结肠直肠癌根治术操作指南(2018版).中华消化外科杂志,2018,17(9):877-885.
[9]杨斌,周声宁,韩方海.直肠癌手术预防性回肠造口并发症的预防和处理.结直肠肛门外科，2020,26(5):548-552.
[10]Gao F, Xu M, Song F, et al. Prevention of an astomotic fistula formation after lowposition Dixon operation. Pak Med Sci,2014,30(5):1007-1010.
[11]李伟,宋巍巍,张学峰,等.预防性回肠末端造口在腹腔镜直肠癌根治术中的应用价值.重庆医学,2019,48 (11):1882-1886.
[12]沈荐,李敏哲,杜燕夫,等.腹腔镜直肠癌低位前切除术后吻合口漏的危险因素分析.中国微创外科杂志,2017,17(10):873-876.
[13]田震,满一帆,李世宽,等.腹腔镜直肠前切除术后吻合口漏的危险因素分析.腹腔镜外科杂志，2020,25(6):421-427.
[14]骆洋,俞旻皓,樊钊强,等.结直肠外科专业化程度对腹腔镜低位直肠癌手术预防性造口的影响.腹腔镜外科杂志,2021,26(2):112-116.
[15]袁凯涛,马晋平.直肠癌低位前切除术行预防性回肠末端造口是否影响直肠肛门功能——一项随访长达12年的随机多中心研究.中华胃肠外科杂志,2017,20(9):986.

备注/Memo

备注/Memo:
基金项目：镇江市社会发展指导性科技计划项目(FZ2020005)**通讯作者，Email：157540273@qq.com ①(南通大学医学院，南通226019) ②(南通大学附属医院胃肠外科，南通226001)
更新日期/Last Update: 2023-02-23