摘要目的 探讨腹腔镜下预置防粘连补片对老年患者腹会阴联合直肠癌根治术(Miles术)后造口旁疝发生率的影响. 方法 2012年1月至2015年1月我院普外科收治68例低位直肠癌患者,均行腹腔镜Miles术进行治疗.根据术中是否预置造口旁疝补片分为预置补片组38例,未预置补片组30例.比较两组患者手术情况、术后并发症、随访期间并发症以及3年生存情况. 结果 预置补片组患者手术时间长于未预置补片组[(235.7±33.6)min,(194.3±28.9) min,t=5.36,P=0.000].术后3年,预置补片组并发症发生率低于未预置补片组[10.5％(4/38)和90.0％(27/30),x2 =42.69,P=0.000].局部复发率、远处转移率和3年总生存率预置补片组分别为23.7％(9/38)、31.6％(12/38)和71.1％(27/38),未预置补片组分别为23.3％(7/30)、33.3％(10/30)和70.0％(21/30),两组患者差异均无统计学意义(x2=0.06,0.02,0.01,P=0.800,0.878,0.925). 结论 腹腔镜下预置防粘连补片能够显著降低老年患者Miles术后造口旁疝的发生率,值得推广.

abstractsObjective To investigate the effect of pre-implanted anti-adhesion patch under laparoscopic approach in a Miles' operation on the incidence of parastomal hernia in elderly patients.Methods A total of 68 patients with low rectal cancer admitted into our general surgery department were enrolled in the study from January 2012 to January 2015.All patients received laparoscopic assisted Miles operation.According to whether or not the pre-implanted anti adhesion patch was used during the operation,the 68 cases were divided into pre-implanted patch group(n=38)and the non-implanted patch group(n=30).The operation states,postoperative complications,complications during follow-up and 3-year survival rate were compared between the two groups.Results The operation duration was longer in the pre-implanted patch group than in the non-implanted patch group[(235.7± 33.6)min vs.(94.3±28.9)min,t =5.36,P=0.000].The incidence of complications was lower in the pre implanted patch group than in the non-implanted patch group at 3 years after operation[10.5％ (4/38)vs.90.0％(27/30),x2 =42.69,P =0.000].The local recurrence rate,distant metastasis rate and 3-year overall survival rate had no significant difference between the two groups[23.7 ％ (9/38)vs.23.3％ (7/30),31.6％ (12/38) vs.33.3％ (10/30) and 71.1％ (27/38) vs.70.0％ (21/30)respectively,x2=0.06,0.02 and 0.01,P=0.800,0.878 and 0.925].Conclusions Pre-implanted anti-adhesion patch under laparoscopic approach can significantly reduce the incidence of parastomal hernia in elderly patients after a Miles' operation,which is worthy of promotion.