Application of protective appendicostomy after sphicter-preserving surgery for patients with low rectal carcinoma who are at high-risk of anastomotic leakage
10.3760/cma.j.issn.1671-0274.2015.06.014
- VernacularTitle:阑尾残端预防性造瘘在高危吻合口瘘患者低位直肠癌保肛手术中的应用
- Author:
Xiaolan YOU
1
;
Yuanjie WANG
;
Xiaojun ZHAO
;
Yanjun LIAN
;
Ning XU
;
Chuanjiang HUANG
Author Information
1. 225300,江苏省泰州市人民医院胃肠外科
- Keywords:
Rrectal neoplasms,low;
Anastomotic leakage;
Preventive colostomy;
Appendix stump
- From:
Chinese Journal of Gastrointestinal Surgery
2015;(6):573-576
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the application of protective appendicostomy after sphicter-preserving surgery for patients with low rectal carcinoma who are at high-risk of anastomotic leakage. Methods Clinical data of 74 low rectal cancer cases with high-risk anastomotic leakage undergoing laparoscope-assisted total mesorectal excision (TME) sphincter-preserving operation in our department from September 2013 to September 2014 were analyzed retrospectively. Patients were randomly divided into two groups: 36 patients received appendicostomy and catheter was removed 4 to 6 weeks after operation when sinus tract formation in abdominal wall was identified; 38 patients received traditional ileostomy and stoma closure was performed 3 to 6 months after operation. Results The operation time was (149.2±9.4) min vs. (146.7±12.7) min, postoperative complication morbidity was 8.3%(3/36) vs. 13.2%(5/38), anastomotic leakage rate was 2.8%(1/38) vs. 2.6%(1/36), mean drainage volume of 1-week stoma was (203.2±76.9) ml vs. (195.8±76.5) ml, intestinal function recovery time was (25.5±5.6) h vs. (24.0±5.8) h in intubation colostomy group and ileostomy group respectively, and these differences were not significant (all P>0.05). While total hospital stay was shorter and cost was less in intubation colostomy group as compared to ileostomy group [(8.8±1.7) d vs. (18.0±1.7) d, (32 000±3000) yuan vs. (51 000±4000) yuan], and these differences were significant (all P<0.05). Conclusion For low rectal cancer patients who are at high-risk of developing anastomotic leakage undergoing sphincter-preserving anterior resection , protective appendicostomy can decrease anastomotic leakage rate, avoid second stoma closure, shorten hospital stay and reduce hospital cost.
