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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 183 -186. doi: 10.3877/cma.j.issn.1674-392X.2018.03.006

所属专题： 文献；

论著

经腹膜外造口对低位直肠癌患者术后旁疝及排便功能的研究
卜延志1,†()   
  1. 1. 223400　江苏淮安，涟水县人民医院普外科
  • 收稿日期:2017-07-14 出版日期:2018-06-18
  • 通信作者: 卜延志

Effect of extraperitoneal colostomy on postoperative hernia and defecation function in patients with low rectal cancer

YanZhi Bu1,†()   

  1. 1. Department of General Surgery, People's Hospital of LianShui County, JiangSu 223400, China
  • Received:2017-07-14 Published:2018-06-18
  • Corresponding author: YanZhi Bu
  • About author:
    Corresponding author: Bu Yanzhi, Email:
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卜延志. 经腹膜外造口对低位直肠癌患者术后旁疝及排便功能的研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2018, 12(03): 183-186.

YanZhi Bu. Effect of extraperitoneal colostomy on postoperative hernia and defecation function in patients with low rectal cancer[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2018, 12(03): 183-186.

目的

探讨经腹-会阴联合直肠癌根治术后腹膜内造口与腹膜外造口对行腹腔镜手术治疗患者并发症及人工肛门控制排便能力影响。

方法

选取2013年4月至2016年4月，涟水县人民医院收治的43例低位直肠癌患者，依据临床处理方法将其分为经腹膜外造口患者为观察组（21例，失访1例）；经腹膜内造口患者为对照组（22例，失访2例），对比2组患者造口并发症及术后排便能力的差距。

结果

（1）造口并发症情况比较：造口旁疝，观察组0，对照组2例，差异有统计学意义（P<0.05）；造口水肿，观察组4例，对照组1例，差异有统计学意义（P<0.05）。（2）对患者人工肛门排便控制能力进行比较，随访6个月，差异无统计学意义（P>0.05）；随访1年，差异有统计学意义（P<0.05）。（3）对患者综合评价优良率进行比较，随访6个月，2组差异无统计学意义（P>0.05）；随访1年，观察组高于对照组，差异有统计学意义（P<0.05）。

结论

经腹-会阴联合直肠癌根治术后采用经腹膜外造口方式能够有效降低旁疝发生率，能够更好的对排便能力进行控制。

关键词: 腹腔镜, 造口术, 并发症
Objective

To analyze the effect of intraperitoneal colostomy and extraperitoneal colostomy on postoperative hernia and defecation function of artificial anal for patients undergoing abdominoperineal resection.

Methods

From April 2013 to April 2016, 43 cases of patients with rectal cancer in Lianshui People's hospital were enrolled. The patients were divided into observation groups with extraperitoneal stoma (21 cases, 1 cases were lost); and intraperitoneal colostomy patients as the control group (22 cases, 2 cases were lost). The postoperative complications and defecation ability were compared between the two groups.

Results

(1) No parastomal hernia in observation group, 2 in control group, the difference was significant, statistically significant (P<0.05); 4 cases of ostomy edema appeared in observation group and 1 in control group (P<0.05). (2) When comparing the control ability of artificial anal defecation in patients, no difference was found at 6 months follow-up, while the difference was statistically significant at 1year follow-up. The comprehensive evaluation of excellent and good rate were compared between the 2 groups at 6 months and 1 year, the difference was not significant at 6 months but significant at 1year.

Conclusion

Extraperitoneal colostomy can effectively reduce the incidence of parastomal hernia after abdominoperineal resection of rectal cancer, and can better control the defecation ability.

Key words: Laparoscopes, Ostomy, Complications
表1 2组患者基本资料对比（±s）
组别 例数 男/女 平均年龄(岁) 体质量指数(kg/m2) 造口时间(min) 手术时间(min) 出血量(ml)
观察组 20 11/9 59.87±9.27 20.59±1.59 21.16±45.38 233.51±40.25 104.56±47.97
对照组 20 12/8 59.36±8.96 21.37±1.89 19.28±5.25 221.61±40.17 119.47±55.12
t/χ2值 ? 0.638 0.376 -1.798 1.741 1.487 -1.426
P值 ? 0.465 0.701 0.072 0.083 0.142 0.149
表2 2组患者发生造口并发症情况比较[例（%）]
组别 例数 造口狭窄 造口回缩 造口脱垂 造口旁疝 造口周围炎 内疝 造口水肿 造口坏死、缺血 造口出血 合计
观察组 20 0 0 0 0 1(5) 0 4(20) 0 1(5) 6(30)
对照组 20 1(5) 1(5) 1(5) 2(10) 1(5) 0 1(5) 1(5) 0 8(40)
χ2值 ? 4.621 3.024 0.490 5.481 - - 4.290 5.130 4.621 0.728
P值 ? 0.204 0.204 0.468 0.017 1.000 - 0.036 0.204 0.204 0.391
表3 2组患者术后6个月排便能力比较（例）
组别 例数 标准 问题1 问题2 问题3 问题4 问题5 问题6 问题7
对照组 20 A 12 14 13 12 16 15 12
B 6 5 5 5 3 4 7
C 2 1 2 3 1 1 1
观察组 20 A 10 10 9 8 11 12 8
B 8 7 7 7 5 5 7
C 2 3 4 5 4 3 5
χ2值 ? ? 2.567 4.231 6.321 1.322 7.213 4.902 1.324
P值 ? ? 0.153 0.053 0.119 0.293 0.069 0.065 0.067
表4 2组患者术后1年排便能力比较（例）
组别 例数 标准 问题1 问题2 问题3 问题4 问题5 问题6 问题7
对照组 20 A 5 5 6 5 7 6 6
B 6 7 4 5 6 9 5
C 9 8 10 10 7 5 9
观察组 20 A 2 4 1 1 4 3 3
B 4 8 4 6 8 7 6
C 14 8 15 13 8 10 11
χ2值 ? ? 3.122 2.198 6.321 3.717 3.619 2.987 3.001
P值 ? ? 0.004 0.029 0.000 0.000 0.003 0.004 0.004
表5 比较术后2组患者排便控制能力
组别 6个月 1年
对照组 A 14 A 10
B 2 B 4
C 3 C 4
D 1 D 2
优良率[例(%)] 4(20) 6(30)
观察组 A 13 A 3
B 2 B 7
C 3 C 6
D 2 D 4
优良率[例(%)] 5(25) 10(50)
χ2值 1.489 5.574
P值 0.129 0.000
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