直肠癌术后并发改道性结肠炎的临床研究

doi:10.13418/j.issn.1001-165x.2018.03.021

中国临床解剖学杂志 ›› 2018, Vol. 36 ›› Issue (3): 338-342.doi: 10.13418/j.issn.1001-165x.2018.03.021

直肠癌术后并发改道性结肠炎的临床研究

欧阳满照¹，　廖天佑¹，　伍锦浩¹，　张伟杰¹，　罗振涛¹，　唐立¹，　姚学清²

1. 南方医科大学顺德医院胃肠外科，广东佛山 528308；　2. 广东省人民医院普通外科，广州 510080

收稿日期:2018-03-10 出版日期:2018-05-25 发布日期:2018-07-04
通讯作者: 姚学清，主任医师，博士生导师，E-mail:yjb9211@21cn.com
作者简介:并列第一作者：欧阳满照 (1979-)，副主任医师，硕士生导师，主要从事胃肠外科学研究；廖天佑(1992-)，湖南衡阳人，胃肠外科在读硕士研究生
基金资助:
广东省科技计划项目（2014A020212053，2014A020212 636，2016A020215128，2017A030223006），广东省医学科研基金项目（B2013374，A2014718，A2017160），广州市科技项目（20170402077），佛山市十三五重点专科项目(FSGSPZD135051)

Clinical research of diversion colitis in patients after rectal cancer surgery

OUYANG Man-zhao¹, LIAO Tian-you¹, WU Jin-hao¹, ZHANG Wei-jie¹, LUO Zhen-tao¹, TANG Li¹, YAO Xue-qing²

1. Department of Gastrointestinal Surgery, Shunde Hospital，Southern Medical University, Guangdong, Foshan 528308；2. Department of General Surgery, Guangdong General Hospital＆Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China

Received:2018-03-10 Online:2018-05-25 Published:2018-07-04

摘要/Abstract

摘要：

目的　探讨直肠癌术后改道性结肠炎的发生情况、临床症状和肠镜特点，以期能够提高临床对改道性结肠炎的认识。方法　将89例直肠癌保护性造瘘患者与375例直肠癌未造瘘患者的临床症状和内镜资料进行回顾性对比分析。结果　造瘘组中有30例出现改道性结肠炎的临床症状，其腹痛、肛门粘液便、粘液血便的发生率分别为14.6%、23.6%和12.4%，均高于未造瘘组的2.9%、5.1%和1.9% (均P<0.05)；造瘘组内镜检出其旷置结肠黏膜出现红斑肿胀、糜烂溃疡、炎性滤泡样增生、炎性息肉以及吻合口狭窄的阳性率分别为93.3%、29.2%、15.7%、29.2%和15.7%，均高于未造瘘组的14.1%、7.5%、0.5%、6.7%、4.5%(P<0.05)；造瘘组T淋巴细胞外周血绝对计数CD3+ (980±475)个/μl、CD4+ (550±243)个/μl、CD8+ (342±206)个/μl和CD4+/ CD8+比值1.94±1.44，与未造瘘组相比无统计学差异 (P＞0.05)。结论　改道性结肠炎在直肠癌造瘘术后3月左右即有较高的发生率，内镜检查有助于该病的临床早期诊断以得到及早的对症治疗。

关键词: 改道性结肠炎, 　直肠癌, 　回肠造瘘术, 　并发症

Abstract:

Objective　To investigate the occurrence, clinical symptoms and colonoscopy characteristics of diversion colitis after rectal cancer, so as to improve the clinical understanding of it. Methods　The clinical symptoms and endoscopic data of 89 cases and 375 cases with or without protective ostomy after rectal cancer surgery were retrospectively analyzed.　Results　In the ostomy group, 30 cases showed the clinical symptoms of diversion colitis, and the incidences of abdominal pain, excreting mucus or mucous bloody stools were14.6%, 23.6% and 12.4% respectively, which were all higher than those without ostomy 2.9% 5.1% and 1.9% respectively (P<0.05). The positive rates of erythema swelling, erosion and ulcers, inflammatory follicular hyperplasia, inflammatory polyps and anastomotic stenosis in ostomy group were 93.3%，29.2%，15.7%，29.2%，15.7% respectively, significantly higher than those without ostomy (14.1%, 7.5%, 0.5%, 6.7% and 4.5% respectively). However, the absolute count of CD3+ (980±475) / μl, CD4+ (550±243) / μl, CD8+ (342±206) / μl, and CD4+ / CD8+ ratio (1.94±1.44) in ostomy group showed no statistical difference when compared with those without ostomy (P>0.05).　Conclusion　Diversion colitis has a high incidence in about 3 months after colorectal diversion. Endoscopy enables early clinical diagnosis of the disease for early symptomatic treatment.

Key words: Diversion colitis, 　Rectal cancer, 　Ileostomy, 　Complication

欧阳满照,廖天佑,伍锦浩,张伟杰,罗振涛,唐立,姚学清. 直肠癌术后并发改道性结肠炎的临床研究[J]. 中国临床解剖学杂志, 2018, 36(3): 338-342.

OUYANG Man-zhao, LIAO Tian-you, WU Jin-hao, ZHANG Wei-jie, LUO Zhen-tao, TANG Li, YAO Xue-qing. Clinical research of diversion colitis in patients after rectal cancer surgery[J]. Chinese Journal Of Clinical Anatomy, 2018, 36(3): 338-342.

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直肠癌术后并发改道性结肠炎的临床研究

Clinical research of diversion colitis in patients after rectal cancer surgery

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