朱融慧 周兴舰 邱铖 郭超阳

【摘要】 目的：探讨保护性造口在腹腔镜下超低位直肠癌根治术中的安全性及有效性。方法：回顾性分析2019年9月—2023年4月萍乡市人民医院收治的70例行腹腔镜下超低位直肠癌根治术患者的临床资料，将未接受保护性造口患者设为对照组（n=38），接受预防性末端回肠造口术患者设为观察组（n=32）。比较两组围手术期指标、炎症因子水平、大便失禁状况及并发症。结果：观察组手术时间长于对照组，首次排便时间、首次通气时间及术后住院时间均短于对照组（P<0.05）；两组术中出血量比较，差异无统计学意义（P>0.05）；术后72 h两组C反应蛋白（CRP）与中性粒细胞（N）均较术后24 h下降，且观察组CRP、N均低于对照组（P<0.05）；术后6个月两组Wexner失禁评分均下降，术后1、3、6个月欧洲癌症研究与治疗组织（EORTC）生命质量问卷-C30（QLQ-C30）得分呈上升趋势，且观察组Wexner失禁评分低于对照组，EORTC QLQ-C30得分均高于对照组（P<0.05）；观察组并发症总发生率（6.25%）低于对照组（23.68%）（P<0.05）。结论：对腹腔镜下超低位直肠癌根治术患者予以保护性造口具有较好安全性，能促进肛门功能恢复，对机体影响较小，并可提升生活质量。

【关键词】 保护性造口 腹腔镜 超低位直肠癌根治术 安全性 有效性

Study on the Safety and Efficacy of Protective Ostomy in Laparoscopic Radical Resection of Ultra-low Rectal Cancer/ZHU Ronghui， ZHOU Xingjian， QIU Cheng， GUO Chaoyang. //Medical Innovation of China， 2024， 21（15）： -143

[Abstract] Objective： To study the safety and efficacy of protective ostomy in laparoscopic radical resection of ultra-low rectal cancer. Method： The clinical data of 70 patients undergoing laparoscopic radical resection of ultra-low rectal cancer treated in Pingxiang People's Hospital from September 2019 to April 2023 were retrospectively analyzed. Patients who did not receive protective ostomy were set as the control group （n=38） and patients who received prophylactic terminal ileostomy were set as the observation group （n=32）. Perioperative indexes， inflammatory factors levels， situation of fecal incontinence and complications were compared between the two groups. Result： The operation time of observation group was longer than that of control group， and the first defecation time， first exhaust time and postoperative hospitalization time were shorter than those of control group （P<0.05）. There was no significant difference in intraoperative bleeding volume between the two groups （P>0.05）. C reactive protein （CRP） and neutrophil （N） in both groups were decreased 72 h after surgery compared with 24 h after surgery， and CRP and N in observation group were lower than those in control group （P<0.05）. The Wexner incontinence scores in both groups were decreased 6 months after surgery， and the european organization for research and treatment of cancer （EORTC） quality of life questionnaire （QLQ-C30） scores showed an increasing trend 1， 3，

6 months after surgery， and the Wexner incontinence score of the observation group was lower than that of the control group， EORTC QLQ-C30 scores were higher than those of the control group （P<0.05）. The total complication rate of observation group （6.25%） was lower than that of control group （23.68%） （P<0.05）. Conclusion： Protective ostomy for patients undergoing radical ultra-low rectal cancer under laparoscope has good safety， can promote the recovery of anal function， has less impact on the body， and can improve the quality of life.

[Key words] Protective ostomy Laparoscope Radical resection of ultra-low rectal cancer Safety Efficacy

First-author's address： Department of General Surgery Ⅲ， Pingxiang People's Hospital， Pingxiang 337000， China

doi：10.3969/j.issn.1674-4985.2024.15.033

据统计，低位直肠癌在直肠癌中占65%～75%，其中超低位直肠癌是指肿瘤位于肛缘上5 cm内，目前临床多以手术治疗为主[1-2]。近年来，腹腔镜下手术因其创伤小、安全性高、并发症少等优点逐渐成为直肠癌首要治疗手段，且成全了超低位直肠癌患者保肛的诉求，但术后仍有可能发生吻合口瘘，因此如何降低吻合口瘘的发生是目前临床研究的重难点[3]。有研究指出，保护造口能有效避免吻合口瘘的出现或减轻吻合口瘘的临床表现[4]，但又有学者指出保护性造口无法降低吻合口瘘发生率[5]。有关保护性造口是否可以有效降低腹腔镜下超低位直肠癌术后吻合口瘘发生率目前仍有争议。基于此，本研究对保护性造口应用于腹腔镜下超低位直肠癌根治术中的安全性及有效性进行探究，现报道如下。……