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目的探讨保护性回肠造口在直肠癌超低位前切除术中降低吻合口瘘发生率的临床价值。方法分析2003年1月至2005年9月在直肠癌超低位前切除术中施行与未施行保护性回肠造口患者的吻合口瘘发生情况。结果施行保护性回肠造口的39例患者仅2.6%(1例)发生吻合口瘘,但无自觉症状;平均住院时间为12(9-16)d。未施行保护性回肠造口的65例患者中吻合口瘘发生率12.3%(8例),分别予以横结肠造口、Hartmann术和腹会阴联合切除术及营养支持与局部冲洗引流治疗后愈合;出现吻合口瘘的患者平均住院时间为52(36-78)d。结论在直肠癌超低位前切除术中施行保护性回肠造口能降低吻合口瘘的发生率。
Objective To investigate the clinical value of protective ileostomy in reducing the incidence of anastomotic fistula in ultra-low anterior resection of rectal cancer. Methods The incidence of anastomotic fistula between January 2003 and September 2005 in patients undergoing ultraprecision resection of rectal cancer with or without protective ileostomy was analyzed. Results Of the 39 patients with protective ileostomy, only 2.6% (1 case) developed anastomotic fistula, but no symptoms; the average length of stay was 12 (9-16) days. Among the 65 patients without protective ileostomy, the incidence of anastomotic fistula was 12.3% (8 cases), which were treated by transverse colostomy, Hartmann’s surgery and perineal perineal resection combined with nutritional support and local irrigation and drainage, respectively. The average hospital stay for anastomotic fistula was 52 (36-78) days. Conclusions The protective ileostomy can reduce the incidence of anastomotic fistula during the ultra-low anterior resection of rectal cancer.