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目的介绍结肠内旁路技术在中低位直肠癌保肛术中的应用方法并评价其临床意义。方法 148例中低位直肠癌患者随机分成两组:一组为研究组(78例),在行直肠癌低位前切除的基础上,用生物可降解吻合环及避孕套在吻合口上方5cm处做成结肠内旁路以保护吻合口;一组为对照组(70例),在行直肠癌低位前切除术的基础上,附加预防性末端回肠造口。观察两组治疗结果。结果两组患者在性别、年龄、肿瘤位置、肿瘤大小、吻合口距肛缘距离等生理、病理因素方面差异无统计学意义(P>0.05)。两组术后肠功能恢复时间均为2～5天(P>0.05)。研究组吻合口瘘发生率6.4%(5/78),吻合环自然排出时间为术后14～23天(平均17天),无引流管相关并发症,术后6个月内有5.1%(4/78)的病例出现轻度吻合口狭窄,吻合口瘘者漏后引流时间平均7.1天;对照组吻合口瘘发生率10.0%(7/70),37.1%(26/70)的病例伴有造口相关并发症,6个月后有30%(21/70)的病例出现吻合口轻度狭窄,5.7%(4/70)的病例出现吻合口重度狭窄,需进行松解治疗,吻合口瘘后引流时间平均18.2天。两组吻合口瘘发生率差异无统计学意义(P>0.05)。但在吻合口瘘后骶前引流管引流时间及术后6个月吻合口狭窄方面两组差异有统计学意义(P<0.05)。结论与预防性回肠末端造口相比,结肠内旁路技术简单,安全,可有效保护吻合口,降低了吻合口瘘带来的风险,减少了吻合口狭窄的发生率。
Objective To introduce the application of colonic bypass technique in the anal sphincter preservation of low and middle rectal cancer and to evaluate its clinical significance. Methods 148 cases of low rectal cancer patients were randomly divided into two groups: one for the study group (78 cases), in the rectal cancer low anterior resection based on the use of biodegradable staples and condoms in 5cm above the anastomotic do Into the colonic bypass to protect the anastomosis; a group of control group (70 cases), in the line of anterior resection of low anterior resection based on the additional preventive ileostomy. The two groups were observed treatment results. Results There were no significant differences in the physical and pathological factors between the two groups in terms of sex, age, tumor location, tumor size, anastomotic distance from the anal verge (P> 0.05). The recovery time of intestinal function in both groups was 2 to 5 days (P> 0.05). The incidence of anastomotic fistula was 6.4% (5/78) in the study group, and the spontaneous discharge time of the anastomosis ring was 14 to 23 days (mean, 17 days) after operation. There was no drainage-related complications and the rate of 5.1% 4/78) had mild anastomotic stenosis. The average drainage time after anastomotic leakage was 7.1 days. The incidence of anastomotic leakage was 10.0% (7/70) in the control group and 37.1% (26/70) in the control group There were ostomy-related complications, mild stenosis in 30% (21/70) of 6 months and severe anastomotic stenosis in 5.7% (4/70) of cases, requiring release therapy and anastomosis Oral fistula drainage time after an average of 18.2 days. There was no significant difference in the incidence of anastomotic fistula between the two groups (P> 0.05). However, there was significant difference between the two groups in drainage time of presacral drainage tube and anastomotic stenosis at 6 months after anastomotic fistula (P <0.05). Conclusion Compared with prophylactic distal ileostomy, intracolonic bypass technique is simple and safe, which can effectively protect the anastomosis, reduce the risk of anastomotic leakage and reduce the incidence of anastomotic stenosis.