一针法回肠造口在后期回肠造口还纳手术中应用价值的前瞻性分析

目的探讨一针法回肠造口在后期回肠造口还纳手术中的应用价值。方法采用前瞻性随机对照研究方法。选取2016年1月至2020年7月郑州大学附属肿瘤医院收治的141例行直肠癌低位前切除+预防性回肠造口术病人的临床病理资料,剔除未行造口还纳手术病人14例,最终入组127例。按照随机数字表法将病人分为两组。行一针法回肠造口设为观察组;行传统回肠造口设为对照组。观察指标:(1)入组病人分组情况。(2)回肠造口还纳手术情况。(3)术后情况。(4)随访情况。采用门诊和电话方式进行随访,直肠癌低位前切除+预防性回肠造口术后每个月随访1次,随访至回肠造口还纳手术后3个月,了解病人随访期间的并发症及死亡情况。随访时间截至2020年7月。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验;偏态分布的计量资料以M(P25,P75)或M(范围)表示,组间比较采用Mann-Whitney U检验。计数资料以绝对数表示,组间比较采用χ²检验。等级资料组间比较采用Mann-Whitney U检验。结果(1)入组病人分组情况:筛选出符合条件的病人127例;中位年龄为64岁,年龄范围为31~83岁。127例病人中观察组66例,对照组61例。(2)回肠造口还纳手术情况:两组病人均顺利完成回肠造口还纳手术。观察组和对照组病人切口长度,手术时间,术中出血量,术中粘连程度(轻度粘连、明显粘连)分别为4.25 cm(4.00 cm,5.00 cm)和7.50 cm(7.00 cm,8.50 cm),48.00 min(33.75 min,58.00 min)和70.00 min(57.00 min,80.00 min),30 mL(20 mL,50 mL)和30 mL(30 mL,50 mL),34、32例和13、48例,两组病人上述指标比较,差异均有统计学意义(Z=-9.549、-6.133、-2.758,χ²=12.405,P<0.05)。(3)术后情况:观察组和对照组病人切口感染分别为5例和13例,两组比较,差异有统计学意义(χ²=4.917,P<0.05)。(4)随访情况:127例病人均获得随访,随访时间为6~21个月,中位随访时间为10个月。随访期间仅对照组3例病人出现术后切口疝,经保守治疗痊愈。两组病人均未出现吻合口瘘相关并发症和死亡病例。结论一针法回肠造口具有造口还纳的优势,能有效缩短回肠造口还纳手术的操作时间,减少术中出血量,缩短切口长度,降低术后切口感染并发症发生率。

Application value of one-stitch prophylactic ileostomy in late ileostomy closure:a prospective analysis

Objective To investigate the application value of one-stitch prophylactic ileostomy in late ileostomy closure.Methods The prospective randomized control study was conducted.The clinicopathological data of 141 patients with rectal cancer who underwent low anterior resection combined with prophylactic ileostomy in the Affiliated Tumor Hospital of Zhengzhou University from January 2016 to July 2020 were selected.There were 127 patients being selected after excluding 14 cases who did not undergo ileostomy closure.Patients undergoing one-stitch prophylactic ileostomy were divided into observation group,ad patients undergo tradial ileostomy were divided into control group.Observation indicators:(1)groupings of the enrolled patients;(2)surgical situations of ileostomy closure;(3)postoperative situations;(4)follow-up.Folw-up was conducted using outpatient examination and telephone interview once a month after low anterior resection combined with prophylactic ileostomy to detect complication and death of patients.The end point was at 3 months after ileostomy closure.The follow-up was up to July 2020.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the independent sample t test.Measurement data with skewed distribution were represented as M(P25,P75)or M(range),and comparison between groups was conducted using the Mann-Whitney U test.Count data were described as absolute numbers,and comparison between groups was conducted using the chi-square test.Comparison of ordinal data between groups was conducted using the Mann-Whitney U test.Results(1)Grouping situations of the enrolled patients:a total of 127 patients were selected for eligibility,aged from 31 to 83 years,with a median age of 64 years.Of 127 patients,there were 66 cases in observation group and 61 cases in control group.(2)Surgical situations of ileostomy closure:all patients from the two groups underwent ileostomy closure successfully.The incision length,operattime,volume of intraoperative blood loss,cases with abdoal adhesion degree as slight adhesion or obvious adhesion were 4.25 cm(4.00 cm,5.00 cm),48.00 minutes(33.75 minutes,58.00 minutes),30 mL(20 mL,50 mL),34,32 of the observation group,versus7.50cm(7.00cm,8.50cm),70.00 minutes(57.00 minutes,80.00 minutes),30 mL(30 mL,50 mL),1,48 of the control group,showing significant differences between the two groups(Z=-9.549,-6.133,-2.758,χ²=12.405,P<0.05).(3)Postoperative situations:cases with incision infection of the observation group and the control group were 5 and 13,respectively,showing a significant difference between the two groups(χ²=4.917,P<0.05).(4)Follow-up:all the 127 patients were followed up for 6-21 months,with a median follow-up time of 10 months.During the follow-up,3 cases of the control group had postoperative incisional hernia and were cured after conservative treatment.None of patient had anastomotic leakage related complications or died during the follow-up.Conclusion The one-stitch preventive ileostomy has the advantage of ileostomy closure,which can reduce the operation time,volum intraoperative blood loss and shorten the incision length effectively,so as to reduce the incidence of postoperative incision infection related complications.