中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (06): 691-697.DOI: 10.19538/j.cjps.issn1005-2208.2025.06.16

• 论著 • 上一篇    下一篇

经下腹正中取标本切口自体组织支架法回肠造口在直肠癌低位前切除手术中应用研究

郑忠强，仇广林，蔡林弟，王惠君，廖新华，车向明，李徐奇，樊    林   

  1. 西安交通大学第一附属医院普通外科，陕西西安710061
  • 出版日期:2025-06-01 发布日期:2025-07-01

  • Online:2025-06-01 Published:2025-07-01

摘要： 目的    探讨经下腹正中取标本切口自体组织支架法预防性回肠造口在直肠癌低位前切除术中的临床价值。方法    回顾性分析2021年1月至2023年12月西安交通大学第一附属医院普通外科收治的66例直肠癌病人临床资料，均行低位前切除术联合预防性回肠造口术。根据手术方式分为观察组（自体组织支架法，n=25）与对照组（传统法，n=41），对比两组造口时间、术中出血量、术后恢复指标及并发症发生率。结果    两组基线资料差异均无统计学意义（P＞0.05）。观察组造口时间显著短于对照组［（10.16±4.27）min vs.（19.63±3.84）min，P＜0.001］，术后首次胃肠功能恢复时间更短［（2.04±0.73）d vs.（2.41±0.59）d，P=0.026］，造口还纳切口长度更短［（5.26±0.86）cm vs.（5.87±0.85）cm，P=0.007］，且腹腔中/重度粘连发生率显著降低（24.0% vs. 53.7%，P=0.018）。观察组造口旁疝发生率高于对照组（24.0% vs.2.4%， P=0.019），但均为隐匿性疝，术中探查修补后未增加二次手术风险。粪水性皮炎、造口回缩等并发症组间差异无统计学意义（P＞0.05）。结论    短期随访结果显示，经下腹正中切口自体组织支架法可缩短造口及还纳手术时间，降低腹腔粘连风险，虽可能增加隐匿性造口旁疝发生率，但未影响临床结局，是预防性回肠造口的优选方案。

关键词: 直肠癌, 预防性回肠造口, 自体组织支架法, 低位前切除术, 腹腔粘连, 造口旁疝, 微创手术, 加速康复外科

Abstract: To investigate the clinical value of prophylactic ileostomy using an autologous tissue scaffold technique via a lower midline specimen extraction incision in low anterior resection for rectal cancer. Methods    Clinical data of 66 rectal cancer patients who underwent low anterior resection with prophylactic ileostomy at the Department of General Surgery，First Affiliated Hospital of Xi'an Jiaotong University from January 2021 to December 2023 were retrospectively analyzed. Patients were divided into observation group（autologous tissue scaffold technique，n=25）and control group（conventional technique，n=41）based on surgical approach.Comparisons included stoma creation time，intraoperative blood loss，postoperative recovery parameters，and complication rates. Results    No significant differences were observed in baseline characteristics between groups（P＞0.05）. The observation group demonstrated significantly shorter stoma creation time ［（10.16±4.27）min vs.（19.63±3.84）min，P＜0.001］，earlier postoperative gastrointestinal function recovery ［（2.04±0.73）d vs.（2.41±0.59）d，P=0.026］，and reduced stoma reversal incision length ［（5.26±0.86）cm vs.（5.87±0.85）cm，P=0.007］. Notably，the observation group showed significantly lower incidence of moderate-to-severe abdominal adhesions（24.0% vs.53.7%，P=0.018）.Although the observation group had higher parastomal hernia incidence（24.0% vs.2.4%，P=0.019），all cases were occult hernias detected intraoperatively and repaired without increasing reoperation risk. No significant differences were found in complications like effluent dermatitis or stoma retraction（P＞0.05）. Conclusion The autologous tissue scaffold technique via lower midline incision shortens operative time for stoma creation and reversal while reducing abdominal adhesion risks.Although potentially increasing occult parastomal hernia incidence，this approach maintains favorable clinical outcomes and represents an optimal strategy for prophylactic ileostomy.

Key words: rectal cancer, prophylactic ileostomy, autologous tissue scaffold method, low anterior resection, intra-abdominal adhesions, parastomal hernia, minimally invasive surgery, enhanced recovery after surgery