作者：林晓荣，陈龙林，吴焕坤

单位：汕头市潮阳区大峰医院 普外科，福建 汕头 515100

Authors: Lin Xiaorong，Chen Longlin，Wu Huankun

Unit: Department of General Surgery, Dafeng Hospital in Shantou Chaoyang District, Shantou 515100, China

摘要：

目的 探讨末端回肠造瘘在腹腔镜低位直肠癌手术中的应用效果。方法 选取2018年1月至2020年1月汕头市潮阳区大峰医院接受腹腔镜低位直肠癌手术治疗的100例低位直肠癌患者的临床资料，按照随机数字表法分为对照组、试验组，每组各50例。对照组在腹腔镜低位直肠癌手术中不进行末端回肠造瘘，试验组在腹腔镜低位直肠癌手术中实施末端回肠造瘘，比较两组的手术时间、术中出血量、术后疼痛评分、术后血清炎症因子指标、术后恢复时间、住院时间、吻合口瘘发生率、吻合口感染发生率和二次手术率。结果 试验组的手术时间长于对照组（P<0.05），但两组的术中出血量比较差异无统计学意义（P>0.05）。术后12～48 h，观察组试验组的疼痛评分低于对照组（P <0.05）。术后第1天、第2天、第3天，观察组的C反应蛋白、降钙素原水平均低于对照组（P<0.05）。观察组试验组的术后首次排气时间、恢复进食时间、盆腔引流管拔除时间、住院时间均短于对照组（P<0.05）。观察组试验组的吻合口瘘发生率、吻合口感染发生率、二次手术率低于对照组（P<0.05）。结论 在腹腔镜低位直肠癌手术中实施末端回肠造瘘，可有效减轻术后炎症反应和术后疼痛感，降低术后吻合口瘘及感染风险，有利于促进患者术后恢复。

关键词：直肠癌；腹腔镜低位直肠癌手术；末端回肠造瘘；吻合口瘘

Abstract：

Objective To explore the application effect of terminal ileostomy in laparoscopic surgery for low rectal cancer. Method From January 2018 to January 2020, 100 patients with rectal cancer who received laparoscopic surgery for low rectal cancer in our hospital were included in the study. The patients were randomly divided into two groups with 50 cases in each group. In the control group, terminal ileostomy was not performed in laparoscopic low rectal cancer surgery, while in the observation group, terminal ileostomy was performed in laparoscopic low rectal cancer surgery. The operation time, intraoperative blood loss, postoperative pain score, postoperative serum inflammatory factors, postoperative recovery time, hospital stay, incidence of anastomotic leakage, incidence of anastomotic infection and secondary operation rate were compared between the two groups. Result The operation time of the observation group was longer than that of the control group （P<0.05）, but the intraoperative blood loss of the two groups had no significant difference（P >0.05）.From 12 hours to 48 hours after operation, the pain scores of the observation group were lower than those of the control group （P<0.05）.On the 1 st, 2 nd and 3 rd day after operation, the C-reactive protein and calcitonin raw water in the observation group were lower than those in the control group on average （P<0.05）. The first exhaust time, eating recovery time, pelvic drainage tube extraction time and hospital stay in the observation group were shorter than those in the control group （P <0.05）. The incidence of anastomotic leakage, anastomotic infection and the rate of secondary operation in the observation group were lower than those in the control group （P<0.05）. Conclusion The implementation of terminal ileostomy in laparoscopic low rectal cancer surgery can effectively reduce postoperative inflammatory reaction and postoperative pain, reduce postoperative anastomotic leakage, infection and secondary operation risk, and promote postoperative recovery.

Key Words: Rectal cancer；Laparoscopic surgery for low rectal cancer；Terminal ileostomy；Anastomotic fistula