于周满 王淑春

【摘要】目的：在腹腔镜下低位直肠前切除术（LAR）中，为预防术后吻合口瘘我们通常进行预防性回肠造口术。通常回肠造口位置在右下腹，本文中我们实践并研究了于下腹正中切口并行回肠造口的可行性。方法：72位接受LAR术且需要预防性造口的患者入组，对于这些患者我们实施了经下腹正中切口回肠造口术。结果：术后随访，早期（2周）发生下腹坠胀感12例，其中内疝1例，急诊手术解除梗阻并同时还纳;不完全性肠梗阻2例，局麻下扩大造口切口;术后1个月造口回肠脱垂10cm 1例，急诊还纳回肠造口。其余患者术后2-3月还纳，均恢复顺利。结论： LAR术中经下腹正中切口行回肠造口是完全可行的。

【关键词】直肠癌;回肠造口;下腹正中造口

Objective To prevent anastomotic leakage after laparoscopic low anterior resection（LAR）surgery for rectal cancer，we usually perform prophylactic ileostomy. The ileostomy is usually located at right lower quadrant of abdomen. In our study， we aimed at investigating the feasibility of performing ileostomy by median incision of lower abdomen in LAR surgery. Methods We enrolled 72 patients who need to receive LAR surgery and prophylactic ileostomy， then we performed ileostomy by median incision of lower abdomen. Results During the post-operation follow-up， distension of lower abdomen occurred in 12 patients in 2 weeks. Internal hernia occurred in 1 patient， we simultaneously performed emergency surgery to relieve obstruction and ileostomy closure. Incomplete intestinal obstruction occurred in 2 patients，we extended the incision of ileostomy under local anesthesia. Ileum prolapse occurred in 1 patient after 1 month，we performed emergency ileostomy closure. The rest of the patients received ileostomy closure after 2-3 months and recovered uneventfully. Conclusions  we came to the conclusion that the ileostomy by median incision of lower abdomen in LAR surgery is feasible.

【中圖分类号】R246.5  【文献标识码】A   【文章编号】2026-5328（2021）07-027-01

腹腔镜下低位直肠前切除术（LAR）后吻合口漏可能性大，则需要回肠造口分流，在标本取出部位造口是可行的[1]。在标本取出的切口预防造口与另外选择切口造口无明显的差异[2]。

近4年我们对72例低位直肠癌前切除术（LAR），经下腹正中切口行预防性造口，结果满意，现在介绍如下：

临床资料：

本组72人，年龄50～78岁，男性42例，女性30例，Dukes分期：I期4例，II期24例，III期44例。术中病理中分化腺癌52例，低分化腺癌16例，粘液腺癌4例。肿瘤下缘距肛缘3cm 6例，均为女性;肿瘤下缘距肛缘4cm 24例，其中男性16例，女性8例;肿瘤下缘距肛缘5cm  32例，其中男性20例，女性12例;肿瘤下缘距肛缘5cm以上10例，其中男性6例，女性4例。

手术方法：

腹腔镜下直肠癌LAR手术同常规腹腔镜……