摘要
目的观察正中切口行预防性回肠造口对腹腔镜直肠癌根治术患者术后恢复及并发症发生率的影响。方法回顾性分析2022年6月至2024年6月接受腹腔镜直肠癌根治术患者的临床资料,将接受正中切口行预防性回肠造口患者纳入观察组,接受传统切口行预防性回肠造口患者纳入对照组。将两组资料经倾向性评分匹配法进行1:1匹配,共有54对基线资料差异无统计学意义的患者纳入研究。用SPSS24.0软件分析数据。计量资料以(±s)表示,行独立样本t检验和配对样本t检验;计数资料以百分比表示,行Fisher精确概率检验或χ^(2)检验;等级资料比较用秩和检验。P<0.05表示差异有统计学意义。结果观察组造口还纳手术时间间隔明显短于对照组(P<0.05),但还纳手术时间和术中出血量比较差异无统计学意义(P>0.05);术后72h,两组患者疼痛视觉模拟量表(VAS)评分均低于术后24h,且观察组明显低于对照组(P<0.05);术后24h,两组患者血清C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子α(TNF-α)、谷丙转氨酶(ALT)、谷草转氨酶(AST)水平均升高,但观察组血清CRP、PCT、TNF-α水平均低于对照组(P<0.05);观察组患者并发症总发生率明显低于对照组(P<0.05)。结论正中切口行预防性回肠造口相较于传统切口行回肠造口更有利于患者术后恢复,能减轻患者术后疼痛,降低术后并发症的发生率,对于造口还纳手术时间和术中出血量影响不显著,临床应根据患者需求和实际情况选择适宜的造口方式。
Objective To observe the impact of prophylactic ileostomy via median incision on postoperative recovery and complication incidence in patients undergoing laparoscopic radical resection of rectal cancer.Methods A retrospective analysis was performed on the clinical data of patients who underwent laparoscopic radical resection of rectal cancer from June 2022 to June 2024.Patients receiving prophylactic ileostomy via median incision were enrolled in the observation group,and those receiving prophylactic ileostomy via traditional incision were included in the control group.Propensity score matching was used for 1:1 matching of the two groups,with 54 pairs of patients showing no significant baseline differences included in the study.Data were analyzed using SPSS24.0 software.Measurement data were expressed as(±s),and independent sample t tests and paired sample t tests were performed;enumeration data were expressed as percentages,and Fisher’s exact probability test orχ^(2) test was applied;Rank Sum test was used for ordinal data comparison.P<0.05 was considered statistically significant.Results The interval between stoma reversal surgeries in the observation group was significantly shorter than that in the control group(P<0.05),but there were no significant differences in reversal surgery time or intraoperative blood loss between the two groups(P>0.05).At 72 hours postoperatively,the visual analog scale(VAS)pain scores in both groups were lower than those at 24 hours postoperatively,and the observation group had significantly lower scores than the control group(P<0.05).At 24 hours postoperatively,serum levels of C-reactive protein(CRP),procalcitonin(PCT),tumor necrosis factor-α(TNF-α),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)increased in both groups,but the observation group had lower serum CRP,PCT,and TNF-αlevels than the control group(P<0.05).The total incidence of complications in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Prophylactic ileostomy via median incision is more conducive to postoperative recovery,alleviates postoperative pain,and reduces the incidence of postoperative complications compared with ileostomy via traditional incision,with no significant impact on stoma reversal surgery time or intraoperative blood loss.Clinically,the appropriate stoma method should be selected based on patients’needs and actual conditions.
作者
肖燕玲
杜升兰
杨春梅
许政文
王玫
Xiao Yanling;Du Shenglan;Yang Chunmei;Xu Zhengwen;Wang Mei(Department of Colorectal Surgery,Suining Central Hospital,Suining Sichuan Province 629000,China;Department of Respiratory Medicine,Suining Central Hospital,Suining Sichuan Province 629000,China)
出处
《中华普外科手术学杂志(电子版)》
2025年第5期539-542,共4页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
四川省护理科研课题(H23030)。
关键词
直肠肿瘤
腹腔镜
正中切口
预防性回肠造口
Rectal Neoplasms
Laparoscopes
Median Incision
Prophylactic Ileostomy
作者简介
通信作者:王玫,Email:2602297200@qq.com。
