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目的比较腹会阴联合切除术患者经腹膜内、外两种乙状结肠造口的临床结果。方法回顾性分析2010年3月至2014年3月期间内江市第二人民医院普外科172例行腹会阴联合切除术患者的临床资料。其中经腹膜内乙状结肠造口60例(经腹膜内组)、经腹膜外乙状结肠造口76例(经腹膜外组)及经腹膜外乙状结肠造口并功能锻炼36例(功能锻炼组)。对比3组患者的手术情况、术后并发症发生情况及造口功能。结果 1手术情况:3组患者在造口定位选择、手术时间、术中出血量及术后住院时间方面比较差异无统计学意义(P>0.05);经腹膜内组和功能锻炼组在术后首次排气和排便时间明显早于经腹膜外组,差异具有统计学意义(P<0.05)。2术后并发症:经腹膜外组和功能锻炼组的造口并发症发生率低于经腹膜内组,差异具有统计学意义(P<0.05);功能锻炼组又低于经腹膜外组,差异也具有统计学意义(P<0.05)。3造口功能:经腹膜外组排便信号出现时间>30 s者所占比例明显高于经腹膜内组,功能锻炼组又高于经腹膜外组,差异均具有统计学意义(P<0.05);经腹膜外组排便信号出现后自主控制排便到排出粪便时间>2 min者所占比例明显高于经腹膜内组,功能锻炼组又高于经腹膜外组,差异均具有统计学意义(P<0.05)。结论腹会阴联合切除术经腹膜外乙状结肠造口较经腹膜内造口术后造口相关并发症少,且控便、排便能力更好。术后功能锻炼能进一步减少造口相关并发症及改善造口功能。
Objective To compare the clinical results of two sigmoid colostomy patients with intraperitoneal and external abdominal perineal resection. Methods The clinical data of 172 patients undergoing perineal perineal resection in General Surgery, Second People ’s Hospital, Neijiang City from March 2010 to March 2014 were retrospectively analyzed. Among them, 60 were intraperitoneally sigmoid colostomy (intraperitoneal group), 76 were extraperitoneal sigmoid colostomy (extraperitoneal group), and extraperitoneal sigmoid colostomy and 36 were functional exercises (functional exercise group). The operation conditions, postoperative complications and stoma function were compared between the three groups. Results 1Operation: There were no significant differences in the choice of ostomy location, operative time, intraoperative blood loss and postoperative hospital stay among the three groups (P> 0.05). After intraperitoneal and functional exercise group The first time of exhaust and defecation was significantly earlier than that of extraperitoneal group, the difference was statistically significant (P <0.05). Postoperative complications: The incidence of ostomy complications in the extraperitoneal group and functional exercise group was lower than that in the intraperitoneal group, the difference was statistically significant (P <0.05); functional exercise group was lower than the extraperitoneal group, The difference was also statistically significant (P <0.05). 3 stoma function: the extraperitoneal group defecation signal appearance time> 30 s, the proportion was significantly higher than the intraperitoneal group, functional exercise group and extraperitoneal group, the difference was statistically significant (P <0.05) ; The rate of spontaneous control defecation to excretion> 2 min after extraperitoneal group defecation signal was significantly higher than that of intraperitoneal group, functional exercise group and extraperitoneal group, the differences were statistically significant (P <0.05). Conclusion Abdominal perineal resection by extraperitoneal sigmoid colostomy stoma than after intra-ostomy related complications less, and control of stool, bowel function better. Postoperative functional exercise can further reduce stoma-related complications and improve stoma.