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目的探讨保护性回肠造口在低位直肠癌双吻合器手术中的意义。方法距肛门6-7cm的低位直肠癌63例分别采用双吻合器手术+保护性回肠造口术(A组,33例)和单用双吻合器手术(B组,30例)。观察加用保护性回肠造口对术后排便和吻合口愈合的影响。结果 A组术后3d内排气排便患者比例高于B组[84.8%(28/33)vs.10%(3/30)](P<0.05)。A组无吻合口瘘发生;术后虽发生吻合口膜状狭窄,但这种狭窄均为用示指扩开的可逆性狭窄。B组发生吻合口瘘4例(13.3%);其中,2例经保持引流管通畅保守治疗后痊愈,另2例行横结肠造口转流痊愈。结论对距肛门6-7cm的低位直肠癌行双吻合器保肛手术中,保护性回肠造口可加快患者尽早进食,预防术后吻合口瘘和吻合口瘢痕狭窄,保护患者术后排便功能。
Objective To investigate the significance of protective ileostomy in the operation of double rectal cancer stapler. Methods Sixty-three patients with low rectal cancer at the anus of 6-7 cm were treated with double stapling operation + protective ileostomy (group A, n = 33) and single double stapling operation (group B, n = 30). To observe the effect of protective ileostomy on postoperative defecation and anastomotic healing. Results The proportion of patients with evacuated bowel in group A was significantly higher than that in group B [84.8% (28/33) vs. 10% (3/30)] (P <0.05). There was no anastomotic fistula in group A; although anastomotic stenosis occurred after operation, this stenosis was reversible stenosis with the index finger expanding. In group B, anastomotic fistula occurred in 4 cases (13.3%). Among them, 2 cases were cured after maintaining conservative treatment of drainage tube, and the other 2 cases were cured by transverse colostomy bypass. Conclusions In the operation of anal sphincter preservation with low rectal cancer of 6-7 cm from the anus, the protective ileostomy can expedite the patient’s early feeding, prevent postoperative anastomotic fistula and anastomotic scar and protect the postoperative bowel function.