直肠癌Miles术后结肠造口的临床研究.DOCVIP

临床医学论文-直肠癌Miles术后结肠造口的临床研究 ?????????? 作者：唐卫 谭春祁 左朝晖 江勃年 陈菊英 王心见 唐自元 陈玉盘 韩卫青 【摘要】? 目的 探讨直肠癌Miles术后结肠造口并发症特点、预防和处理。 方法 回顾性分析我院1998年1月至2008年1月收治300例直肠癌Miles术后结肠造口的临床资料，分析结肠造口并发症的特点及防治措施。结果 结肠造口术后并发症发生率18.0%(54/300)，其中造口缺血坏死2.66%(8/300)，造口旁疝1%(3/300)，腹腔内疝2.33%(7/300)，造口周围炎4.67%(14/300)，造口狭窄3.33%(10/300)，造口回缩4%(12/300)。年龄超过60岁的患者造口并发症发生率明显提高，造口缺血与腹壁外段造口肠管的长度、造口开放方式有关，造口狭窄与腹壁切口直径、造口开放方式有关，造口旁疝和脱垂与患者体形有关。结论 结肠造口并发症发生率与手术方式、患者年龄和体形有密切关系，根据个体情况，选择合理的造口类型和构造，可减少并发症发生率。术中应避免造口段肠管张力过大，肠系膜离断过多，实行一期黏膜皮肤缝合开放造口。 【关键词】? 直肠癌;Miles手术;结肠造口术;并发症 　　[Abstract] Objective To investigate the features, prevention and treatment of colostomyrelated complications after Miles operation for rectal cancer. Methods The clinical data of 300 cases of colostomy after Miles operation for rectal cancer admitted from January 1998 to January 2008 were retrospectively analyzed. The features, prevention and treatment of colostomyrelated complications were analyzed. Results The postoperative morbidity of stomal complications was 18.0% (14/300). The occurrence rates of colostomyrelated complications such as ischemic necrosis dehiscence of stomal mucosa and skin, retraction of stoma, tissue necrosis, parastomal hernia, abodaminal internal hernia, tissue infection, stenosis of stoma, stoma prolapse and tissue edema were 1.0%(3/300), 1.33%(4/300), 1.33%(4/300), 1.67%(5/300), 3.66%(11/300), 4.0%(12/300), 8.0%(24/300), 9.0%(27/300), 10.0%(30/300) and 11.0%(33/300), respectively. Conclusion s The occurrence rate of stomal complications is related to operative procedures and patients age. Rational stomal type and configuration based on individual factors may benefit in reducing complications and improving the quality of life. 　　[Key words] Rectal cancer; Miles operation; Colostomy; Complications 　　Miles手术是治疗低位直肠癌的标准方式之一，虽然低位吻合技术的进步，低位直肠癌保肛率明显提高，但仍有20%～30%的低位直肠癌患者需行腹会阴联合切除和永久性乙状结肠造口[1]。临床观察发现结肠造瘘口易发生内疝、造口回缩、造口狭窄、造口周围炎和组织水肿等并发症。如何有效地减少上述并发症有重要的临床意义。本文回顾性分析我院1998年1月至2008年1月10年收治的300例直肠癌Miles术后结肠造口的临床资料，现报告如下。 　　1 资