腹腔镜直肠癌根治术中预防性末端回肠置管造瘘的临床应用.docVIP

腹腔镜直肠癌根治术中预防性末端回肠置管造瘘的临床应用 2013暨南大学硕士学位论文 中 文 摘 要 目的:探讨腹腔镜直肠癌低位前切除术中施行预防性末端回肠置管造瘘术,在预防及治疗 吻合口瘘的临床效果及价值。 方法:从深圳市人民医院2011年9月至2013 年3月因直肠癌在胃肠外科住院治疗期间的 患者,选取易发生吻合口瘘高风险的患者分为研究组及对照组,在腹腔镜直肠癌低位前切 除术中予以施行末端回肠置管造瘘术研究组和末端回肠造瘘术对照组,收集两组患者 的一般临床资料、术中资料及术后康复指标。观察两组患者术后是否发生吻合口瘘以及吻 合口瘘发生后的治疗情况。 结果:整理两组数据并进行统计学分析,分析结果如下:1、两组患者在年龄P值0.618、 性别P值1.000、肿瘤距齿状线距离P值0.914、TNM分期P值0.935均无统计学意 义,说明两组患者具有临床可比性;2、两组患者在手术时间P值0.345、术中出血量P 值0.708、肿瘤大小P值0.126、术后发生吻合口瘘人数P值1.000均无统计学意义。 研究组的吻合口瘘发生率为 9.1%;对照组的吻合口瘘发生率为 5.6%。两组患者在吻合口 瘘发生后的病情程度、治疗效果及恢复情况无明显差异;3、两组患者在术后肠鸣音恢复 时间P值0.283、术后进食流质时间P值0.636、术后排气时间P值0.492、术后拔 除盆腔引流管时间P值0.942、术后住院天数P值0.632均无统计学意义。 结论:1、在腹腔镜直肠癌低位前切除术中施行末端回肠置管造瘘术与末端回肠造瘘术相 比,同样可以预防或降低术后吻合口瘘的发生,两者在治疗吻合口瘘的临床效果是相同的; 2、末端回肠置管造瘘术可避免二次手术,免除了肠造瘘对患者造成负面影响,改善患者 生活质量,减少患者医疗费用。其是安全可行的,值得临床推广及应用。 关键词:腹腔镜;直肠癌;末端回肠;置管造瘘;吻合口瘘 I 2013暨南大学硕士学位论文 Abstract Objective: To discuss the clinical effect and value of using prophylactic terminal ileum stoma catheter in Laparoscopic radical resection of rectal carcinoma, to prevent and treat of anastomotic fistulaMethods: Patients with rectal cancer during hospitalization in gastrointestinal surgery during the 2011 September to 2013 March in Shenzhen People’s Hospital,choose the easy anastomotic fistula occurred in high risk patients were randomly divided into study group and control group.In laparosopic low anterior resection for rectal cancer in the implementation of terminal ileum catheter fistulizationStudy Group and the terminal ileum fistulationControl group.Index data and postoperative rehabilitation were collected from two groups of patients with postoperative anastomotic fistula and whether anastomotic stoma fistula occurred after treatment.Organize related data,using SPSS13.0 software for statistical analysis of dataResult: All patients were successfully completed the operation and no operation death. Finishing two sets of data and statistical analysis,the analysis results are as follows:1,two groups of patients wit