摘要
目的探讨腹腔镜下腹会阴切除术（LAPR）乙状结肠单腔造口的手术方式，以减少造口并发症的发生。方法63例患者中，低位直肠癌53例，直肠肛管癌10例。有61例用圆形吻合器行乙状结肠与腹壁皮肤吻合造口，2例手工缝合乙状结肠造口。腹腔内腹直肌型结肠造口37例（A组）；腹膜外隧道腹直肌型结肠造口26例（B组）。结果全组在腹腔镜下完成降结肠、乙状结肠和直肠的分离以及会阴部的直肠肛门开放性切除。无中转开腹，无手术死亡。两组的平均手术时间差异无统计学意义（P〉0．05）；而术后人工肛门排气时间[A组（2．4±1．1）d与B组（1．9±0．8）d比较，P〈0．05]、术后平均住院日[A组（19．9±7．8）d与B组（14．5±3．9）d比较，P〈0．01]及造口相关并发症的发生率（A组29．4％，B组4．0％；两组比较P〈0．05）差异均有统计学意义；B组患者术后平均住院日较A组短，造口相关并发症低于A组。结论LAPR手术中。采用圆形吻合器经腹膜外隧道和腹直肌行乙状结肠单腔造口，可有效地减少造口并发症的发生和缩短手术后的住院时间。
Objective To compare two different procedures of colostomy in the laparoscopicassisted abdominoperineal resection （LAPR）, and to reduce the related complications of colostomy. Methods Sixty-three cases with anorectal cancer undergone LAPR from June 2001 to December 2005 were registered and followed up. Circular stapler anastomosis with sigmoid colon and abdominal skin were applied on 61 cases of the colostomy, and 2 cases were hand sutured. All patients were assigned to group A and B. Thirty-seven cases received the procedure of colostomy through the rectus abdominis peritoneally in group A, other 26 cases through extraperitoneal tunnel and the rectus abdominis in group B. Results Descending colon, sigmoid colon and rectum were dissected using laparoscopic instruments in 63 cases. No conversion to open procedure and no operative death occurred in two groups of patients. There was no significant difference between two groups in mean operation time, but significant differences were found in the time of return of bowl function [A group （2.4±1.1）d vs B group （1.9± 0.8）d,P〈0.05], duration of postoperative hospital stay [A group （19.9±7.8）d vs B group （14.5± 3.9）d,P〈 0.01] and stoma related complications （A group 29.4% vs B group 4.0%,P〈 0.05）. Postoperative hospital stay were shorter, and less colostomy related complications were found in group B. Conclusion Colostomy through extraperitoneal tunnel and the rectus abdominis is a better procedure in LAPR, which can reduce the related complications of colostomy and shorten postoperative hospital stay.
出处
《中华胃肠外科杂志》
CAS
2007年第4期326-328,共3页
Chinese Journal of Gastrointestinal Surgery
