腹膜外乙状结肠造口术在腹腔镜Miles术中应用.docVIP

腹膜外乙状结肠造口术在腹腔镜Miles术中应用 　 作者：渠时学,谢光伟,丁硕,李青,马祖泰 【摘要】 目的：评价腹膜外乙状结肠造口术在腹腔镜Miles术中的临床应用效果。方法：将接受腹腔镜Miles术的60例低位直肠癌、肛管癌患者分为两组，实验组30例行腹膜外乙状结肠造口术，对照组30例行传统的腹膜内乙状结肠造口术，比较两组患者的造口并发症和排便功能。所有患者均随访2～38个月，平均22.4个月。结果：实验组30例中，1例发生造口狭窄，无其他造口并发症发生，并发症发生率为3.3%，26例获排便感（86.7%）；对照组30例中，发生造口狭窄1例、造口回缩1例，造口处切口疝1例、肠脱垂2例、腹内疝1例，并发症发生率为20.0%，8例有排便感（26.7%）。两组差异有统计学意义（P＜0.05），实验组发生的与肠造口有关的并发症明显少于对照组，术后排便感明显高于后者。结论：腹膜外乙状结肠造口术具有术后并发症发生率低和排便控制功能较好的优点，可提高患者术后的生存质量，值得临床推广。 【关键词】 乙状结肠造口术；Miles术；腹腔镜术 【Abstract】 Ｏbjective:To explore the clinical effect of extraperitoneal sigmoidostomy in laparoscopic Miles operation.Methods:60 cases with low rectal and anus carcinoma who underwent laparoscopic Miles operation were divided into two groups.The experimental group (30 cases) received extraperitoneal sigmoidostomy while the control group (30 cases) received traditional intraperitoneal procedure.Postoperative complications caused by sigmoidostomy and defecation function in these two groups were compared.All cases were followed up for 238 months (mean 22.4 months).Results:In experimental group,only 1 patient suffered from sigmoidostomic stenosis.The incidence rate of complications caused by sigmoidostomy was 3.3% and 26 patients (86.7%) got feel of defecation.In control group,the incidence rate of complications caused by sigmoidostomy was much higher (20.0%) and only 8 patients (26.7%) got feel of defecation.The posterior complications included 1 case of sigmoidostomic stenosis,1 sigmoidostomic retraction,1 sigmoidostomic incisional hernia,2 colon prolapse,1 abdominal internal hernia.There was significant difference on the two aspects between the two groups(P＜0.05).Conclusions:The extraperitoneal sigmoidostomy has the advantages of less complications and better defecation functions.This operation should be applied widely in clinical practice. 【Key words】 Sigmoidostomy；Miles operation;Laparoscopy 近年，随着腹腔镜技术水平的不断提高及手术器械的完善，对低位直肠癌、肛管癌患者施行腹腔镜腹会阴联合直肠癌或肛管癌根治术（Miles术）已成为可能，通常采用腹膜内乙状结肠造口术，但并发症较多。2004年1月至2007年3月我