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目的探讨腹膜外隧道式乙状结肠造口术在低位直肠癌腹腔镜腹会阴联合切除术后的临床疗效。方法选取在2014年3月1日至2015年10月31日间中国医学科学院肿瘤医院行低位直肠癌行腹腔镜腹会阴联合切除术的71例患者,采用随机数余数分组法,随机分为腹膜外隧道式乙状结肠造口组(研究组35例)和传统经腹膜乙状结肠造口组(对照组36例),分析不同造口方法对手术时间、术后排气时间、术后住院时间、造口旁疝等并发症的影响。结果研究组患者完成造口操作所需时间为(13.4±1.7)min,对照组患者为(21.4±2.6)min,两组比较差异有统计学意义(P<0.001)。研究组患者术后恢复排气时间为(63.4±13.3)h,对照组患者为(43.0±15.0)h,两组比较差异有统计学意义(P<0.001)。研究组患者术后住院时间为(5.9±1.0)d,对照组患者为(6.4±1.0)d,两组比较差异有统计学意义(P=0.030)。随访期间,研究组患者未有造口旁疝的发生,对照组患者出现4例造口旁疝,两组比较差异有统计学意义(P=0.042)。结论腹膜外隧道式乙状结肠造口术不仅可以缩短手术时间,还可以减少术后住院时间及造口旁疝等并发症发生率,值得临床推广。
Objective To investigate the clinical efficacy of extraperitoneal tunnel sigmoid colostomy in the treatment of low rectal cancer after laparoscopic abdominal perineal resection. Methods From March 1, 2014 to October 31, 2015, 71 patients undergoing laparoscopic abdominal perineal resection for low rectal cancer at Cancer Hospital of Chinese Academy of Medical Sciences were randomly divided into peritoneum Outer tunnel sigmoid colostomy group (study group 35 cases) and the traditional peritoneal sigmoid colon ostomy group (36 cases in the control group), analysis of different stoma methods of operation time, postoperative exhaust time, postoperative hospital stay, stoma Bystanders and other complications. Results The time required for stoma operation in study group was (13.4 ± 1.7) min and in control group (21.4 ± 2.6) min, the difference was statistically significant (P <0.001). The duration of postoperative exhaust recovery was (63.4 ± 13.3) h in the study group and (43.0 ± 15.0) h in the control group, with significant difference between the two groups (P <0.001). The postoperative hospital stay was (5.9 ± 1.0) days in study group and (6.4 ± 1.0) days in control group, with significant difference between the two groups (P = 0.030). During the follow-up period, there were no cases of parastomal hernia in the study group and 4 cases of parastomal hernia in the control group. There was significant difference between the two groups (P = 0.042). Conclusion Extraperitoneal tunnel sigmoid colostomy can not only shorten the operation time, but also reduce the incidence of postoperative hospital stay and parastomal hernia and other complications, worthy of clinical promotion.