摘要
目的:评估弓状线入路腹膜外乙状结肠造口术的安全性及其预防术后造口相关并发症的有效性。方法:回顾分析2019年1月至2021年1月接受腹腔镜腹会阴联合切除术的104例患者的临床资料。根据乙状结肠造口方式将患者分为腹膜外组(n=52)与经腹组(n=52)。比较两组基线数据、结肠造口所需时间(自皮肤环行切开至结肠造口环周缝合固定完毕)、围手术期并发症及长期结肠造口相关并发症(包括造口回缩、造口脱垂、造口旁疝、造口周围皮肤腐蚀)。结果:两组患者基线特征差异无统计学意义。腹膜外组与经腹组结肠造口所需时间差异无统计学意义[22(21,26)min vs.23(20,26)min,P=0.478];术后2年、3年,腹膜外组造口旁疝累积发病率低于经腹组(0 vs.11.5%,P=0.027;3.8%vs.19.2%,P=0.028);术后3年,腹膜外组造口脱垂累积发病率更低(0 vs.13.5%,P=0.013)。两组造口周围皮肤腐蚀差异无统计学意义。结论:弓状线入路腹膜外结肠造口术操作简便易行,可有效降低造口旁疝及造口脱垂发生率,具有临床推广应用价值。
Objective:To evaluate the safety of extraperitoneal sigmoid colostomy via arcuate line approach and its effectiveness in preventing stoma-related postoperative complications.Methods:A retrospective analysis was conducted on the clinical data of 104 patients who underwent laparoscopic abdominoperineal resection from Jan.2019 to Jan.2021.Patients were divided into two groups based on the method of sigmoid colostomy:extraperitoneal group(n=52)and transperitoneal group(n=52).The baseline characteristics,time required for colostomy creation(from circumferential skin incision to completion of circular suturing fixation of the colostomy),perioperative complications,and long-term colostomy-related complications(including stoma retraction,stoma prolapse,parastomal hernia,and peristomal skin erosion)were compared between the two groups.Results:There were no statistically significant differences b etween the two groups in terms of baseline characteristics.The median colostomy creation time was comparable[22(21,26)min vs.23(20,26)min,P=0.478].At 2 and 3 years postoperatively,the cumulative incidence of parastomal hernia was significantly lower in the extraperitoneal group compared to the transperitoneal group(0 vs.11.5%,P=0.027;3.8%vs.19.2%,P=0.028).Additiona-lly,at 3 years postoperatively,the cumulative incidence of stoma prolapse was significantly lower in the extraperitoneal group(0 vs.13.5%,P=0.013).There were no significant differences between the two groups in terms of peristomal skin erosion.Conclusions:The extraperitoneal sigmoid colostomy via the arcuate line approach is a simple and feasible technique that effectively reduces the incidence of parastomal hernia and stoma prolapse,and is worthy of clinical promotion.
作者
安小霞
李鑫
夏平钿
王可新
王延磊
戴勇
毛佳佳
张翔
AN Xiaoxia;LI Xin;XIA Pingtian(Department of Colorectal Surgery,Qilu Hospital of Shandong University,Jinan 250012,China)
出处
《腹腔镜外科杂志》
2025年第6期434-438,共5页
Journal of Laparoscopic Surgery
