目的    探讨应用回肠蕈状双腔造口预防腹腔镜直肠癌全直肠系膜切除（TME）术后吻合口漏的可行性。方法    回顾性分析2006年4月至2010年3月辽宁省肿瘤医院大肠外科应用回肠蕈状双腔造口术预防腹腔镜TME术后吻合口漏的65例（造口组）及同期未行预防性造口的腹腔镜直肠癌TME手术85例（未造口组）病人临床资料。腹腔镜下完成低位或超低位吻合后，造口组于距回盲瓣30~40 cm处回肠于右髂前上棘与脐连线外1/3处行双腔造口，回肠沿与纵轴垂直方向切开达1/2周，近端做蕈状乳头高于皮肤0.5 cm，远端回肠平坦式缝合于皮肤。骶前放置双腔引流管。术后3~5个月闭瘘。未造口组仅骶前放置双腔引流管。结果    造口组病人粪便转流彻底。无造口周围皮肤严重腐蚀与不耐受,无死亡病例，无吻合口漏。未造口组5例出现吻合口漏，3例4~8周后愈合，2例行手术造口治疗后治愈，无死亡病例。结论    应用回肠蕈状双腔造口术预防腹腔镜直肠癌TME术后吻合口漏是可行的，造口护理方便，闭瘘创伤小，粪便转流彻底。

Application of preventive ileum fungating double-cavity fistulation in preventing anastomotic leakage after laparoscopic TME of rectal cancer        ZHANG Qing-tong*, LIU Ya-li, WANG Yong-peng, et al. *Department of Large-intestine Surgery, Liaoning Province Cancer Hospital, Shenyang 110042, China
Corresponding author: SONG Chun, E-mail: csong882002@yahoo.com.cn
Abstract    Objective    To study the feasibilitiy of preventive ileum fungating double-cavity fistulation in preventing anastomotic leakage after laparoscopic TME of rectal cancer. Methods    The clinical data of 65 cases of preventive ileum fungating double-cavity fistulation after laproscopic TME and 85 cases not performed fistulation in the same period between April 2006 and March 2010 in Department of Large-intestine Surgery, Liaoning Province Cancer Hospital were analyzed retrospectively. For fistulation group, the surgical method was as following: after finished lower/ ultra lower anastomosis, made ileum fungating double-cavity fistulation with the ileum 30-40 cm to ileocecus on the place of the external 1/3 line from umbilicus to the right anterior superior spine in fistulation group; made vertical incision of 1/2 circle of ileum along with the vertical axis, and made fungi nipple higher than 0.5 cm of skin on proximal ileum, and sutured distal ileum to skin flat; put dual-drainage tube to the anterior sacrum for 3-5 months after operation, then closed the fistula. For non-fistulation group, dual-drainage tube was put to the anterior sacrum only. Results    In fistulation group, feces diverted thoroughly; all the cases had no skin serious corrosion and intolerance surrounding fistula; neither deaths nor anastomotic leakage occurred. In non-fistulation group, 5 cases appeared anastomotic leakage. Among them, 3 cases healed after 4 to 8 weeks and 2 cases were performed colostomy. No death occurred. Conclusion The application of preventive ileum fungating double-cavity fistulation in preventing anastomotic leakage after laparoscopic TME of rectal cancer is feasible with convenient ostomy care, small trauma of closing fistula and thorough feces diversion .