本文選題：腹腔鏡低位直腸癌根治術(shù) + 保肛手術(shù)　； 參考：《鄭州大學(xué)》2016年碩士論文

【摘要】：目的探討預(yù)防性回腸末端造口術(shù)在腹腔鏡低位直腸癌根治性保肛手術(shù)中的可行性、安全性及其臨床療效。方法隨機對照研究2013年2月至2013年4月在河南省人民醫(yī)院胃腸外科行腹腔鏡低位直腸癌根治手術(shù)的96例患者,將其隨機分為實驗組(預(yù)防性造口)與對照組(不進行預(yù)防性造口),每組各48例。實驗組患者常規(guī)進行回腸末端預(yù)防性雙腔造口并在術(shù)前術(shù)中經(jīng)家屬同意并簽字,根治術(shù)后3個月還納預(yù)防性造口。對照組患者給予傳統(tǒng)常規(guī)方式吻合,不進行預(yù)防性造口。研究中,共計86例患者完成試驗,其中實驗組44例,對照組42例。觀察指標如下:1、分別記錄兩組患者一般情況并統(tǒng)計分析。2、記錄并統(tǒng)計手術(shù)耗時、術(shù)中總出血量等手術(shù)情況比較。3、記錄并統(tǒng)計術(shù)后肛門首次排氣時間、術(shù)后首次下床活動時間、術(shù)后補液總天數(shù)、以及平均住院日等指標情況。4、記錄并統(tǒng)計兩組患者術(shù)前以及術(shù)后第2天,第5天WBC、CRP以及前白蛋白實驗室檢測結(jié)果。5、記錄并統(tǒng)計兩組患者術(shù)后吻合口瘺、腹腔感染、吻合口梗阻、術(shù)后尿潴留及肺部感染等并發(fā)癥的發(fā)生情況。6、記錄并統(tǒng)計兩組患者術(shù)后兩周,術(shù)后3個月,術(shù)后半年肛門功能的恢復(fù)情況,并采用徐忠五項十分法評分并分別進行統(tǒng)計分析。結(jié)果1、實驗組和對照組在一般情況方面比較無明顯統(tǒng)計學(xué)差異。(p0.05)。2、與對照組相比,實驗組在手術(shù)時間略長(162.21±25.67)/(179.50±30.86分鐘(p=0.059)、術(shù)中出血量(76.71±24.12)/(75.95±25.08)毫升(p=0.8864)等手術(shù)情況無明顯統(tǒng)計學(xué)差異。3、實驗組術(shù)后第2天經(jīng)口流質(zhì)飲食,對照組與肛門排氣后清流質(zhì)飲食;術(shù)后補液總天數(shù)(d)比對照組明顯縮短(4.1±0.9)/(6.4±1.5)d(p=0.000);在術(shù)后恢復(fù)過程中實驗組患者術(shù)后首次排氣時間明顯早于對照組(2.1±1.1)/(4.8±1.3)d(p=0.000);術(shù)后首次下床時間(d)也比對照組提前(1.8±0.9)/(3.9±1.8)d(p=0.000)。而且對比對照組,平均住院日(d)(8.7±1.2)/(12.9±2.1)d(p=0.000)也明顯縮短。4、兩組患者術(shù)前及術(shù)后第2天wbc、crp、白蛋白以及前白蛋白結(jié)果無明顯差異(p0.05);第5天wbc、crp指標實驗組降低有統(tǒng)計學(xué)意義,實驗組前白蛋白升高具有統(tǒng)計學(xué)差異(p0.05)。5、實驗組患者術(shù)后無一例發(fā)生吻合口瘺,對照組患者術(shù)后有5例患者出現(xiàn)吻合口瘺,均經(jīng)雙腔引流管沖洗后好轉(zhuǎn)。實驗組術(shù)后并發(fā)癥總發(fā)生率6.28%,對照組為21.43%,p=0.009,兩組存在明顯統(tǒng)計學(xué)差異(p0.05)。6、兩組患者術(shù)后14天時,總體生活質(zhì)量無明顯差異均不理想;術(shù)后3個月兩組患者肛門功能均有很大程度恢復(fù),實驗組患者逐漸適應(yīng)造口,總體生活質(zhì)量顯著優(yōu)于對照組;術(shù)后半年,實驗組造口已還納3個月,排便功能恢復(fù)情況優(yōu)于對照組。結(jié)論在腹腔鏡低位直腸癌保肛手術(shù)中,施行預(yù)防性回腸末端雙腔造口術(shù),可降低患者術(shù)后吻合口瘺發(fā)生率,促進患者快速康復(fù),患者術(shù)后肛門功能明顯改善,生活質(zhì)量得以提高。
[Abstract]:Objective to investigate the feasibility, safety and clinical effect of prophylaxis ileostomy in laparoscopic radical anal preservation for low rectal cancer. Methods from February 2013 to April 2013, 96 patients underwent laparoscopic radical resection of low rectal cancer in Henan Provincial people's Hospital. They were randomly divided into two groups: the experimental group (prophylactic orifices) and the control group (48 cases in each group). The patients in the experimental group were treated with prophylactic double-lumen ileostomy before operation and signed by their relatives before operation. The patients received prophylactic anastomosis 3 months after radical operation. Patients in the control group were given conventional anastomosis without prophylactic orifice. In the study, a total of 86 patients completed the test, including 44 cases in the experimental group and 42 cases in the control group. The observation measures were as follows: 1. The general situation and statistical analysis of the two groups were recorded and analyzed. The operation time, the total amount of blood lost during the operation, and so on, were recorded and counted respectively. The time of the first exsufflation of anus and the time of the first time of getting out of bed after operation were recorded and counted. The total days of fluid resuscitation and the average hospital stay. 4. The results of WBCU CRP and prealbumin laboratory test were recorded and counted before operation and on the second day and the fifth day after operation, and the anastomotic fistula was recorded and counted in both groups. The incidence of postoperative complications such as abdominal infection, anastomotic obstruction, postoperative urinary retention and pulmonary infection were recorded and counted. The recovery of anal function was recorded and counted in two weeks, three months and six months after operation. Xu Zhong's five tenths method was used to score the scores and statistical analysis was carried out respectively. Results 1. There was no significant difference in general situation between the experimental group and the control group. There was no significant difference in the operation time between the experimental group (162.21 鹵25.67 / L, 179.50 鹵30.86 minutes) and the intraoperative bleeding volume (76.71 鹵24.12 鹵25.08) ml (0.8864). There was no significant difference between the experimental group and the control group on the second day after operation. The total days of postoperative fluid resuscitation were significantly shorter than that of the control group (4. 1 鹵0. 9 / P) and 6. 4 鹵1. 5 鹵1. 5 days after operation. The first postoperative exhaust time of the patients in the experimental group was significantly earlier than that in the control group (2. 1 鹵1. 1 / 0. 8 鹵1. 3 鹵1. 3 鹵1. 3) and the first time of getting out of bed was 1. 8 鹵0. 9 鹵1. 8 鹵1. 8 days later than that in the control group. In comparison with the control group, the mean hospitalization days were 8.7 鹵1.2 鹵1.2 / L / L 12.9 鹵2.1 / d ~ (0.000), respectively. There was no significant difference between the two groups in the results of pre-operation and postoperative wbcccrp, albumin and prealbumin, and the decrease of wbccrp on the 5th day was statistically significant in the experimental group, and there was no significant difference between the two groups before operation and on the second day after operation (P < 0.05), but there was no significant difference between the two groups (P > 0.05). There was no anastomotic leakage in the experimental group and 5 cases in the control group. The total incidence of postoperative complications was 6.28 in the experimental group and 21.43 in the control group. There was a significant difference between the two groups (p0.05. 6). There was no significant difference in the overall quality of life between the two groups on the 14th day after operation. Three months after operation, the anal function of the two groups recovered to a great extent, the patients in the experimental group gradually adapted to the orifice, the overall quality of life was significantly better than that in the control group, and half a year after the operation, the patients in the experimental group had received the operation for 3 months. The recovery of defecation function was better than that of the control group. Conclusion during laparoscopic anus-preserving surgery for low rectal cancer, the prophylactic operation of double ileostomy can reduce the incidence of anastomotic fistula, promote the rapid recovery of the patients, and improve the anal function of the patients after operation. The quality of life has improved.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R735.37

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