关键词: 低位直肠癌, 保肛手术, 预防性回肠造口, 并发症, 临床选择

Abstract: Objective To compare the perioperative outcomes and clinical prognoses of catheter enterostomy versus conventional enterostomy during laparoscopic anus-preserving surgery for low rectal cancer.Methods A total of 96 patients who underwent laparoscopic anus-preserving surgery for low rectal cancer in the First Hospital of Lanzhou University between January 2023 and December 2024 were enrolled,among whom 86 patients with complete data and follow-up were finally included.According to the different stoma methods,they were divided into two groups.Among them,there were 44 cases in the observation group,who underwent ileal intubation and stoma through the ileocecal valve using a No.24 balloon catheter.There were 42 cases in the control group,who underwent conventional terminal ileal stoma.The family members agreed to implement preventive stoma reduction 3 months after the operation.Perioperative indicators including intraoperative blood loss,operative duration,postoperative fasting time,time to first flatus,length of hospital stay,and total hospitalization cost of the two groups of patients were collected.The incidences of early and late stoma-related complications were recorded,and intestinal function recovery was followed up for 6 months postoperatively.Results The observation group had an operative duration of (80.2±12.0) minutes,intraoperative blood loss of (45.3±10.0) ml,length of hospital stay of (8.5±2.0) days,and total hospitalization cost of (1.8±0.3) ten thousand yuan;the control group had an operative duration of (120.6±15.0) minutes,intraoperative blood loss of (98.7±20.0) ml,length of hospital stay of (12.1±3.0) days,and total hospitalization cost of (3.2±0.5) ten thousand yuan.Statistically significant differences were observed between the two groups (all P<0.05).The incidence of early catheter-related complications was 31.8% in the observation group,slightly higher than 28.6% in the control group;the incidence of late stoma-related complications was 15.9% in the observation group,markedly lower than 88.1% in the control group.The overall complication rate was 23.9% in the observation group versus 58.3% in the control group.Conclusion The two preventive enterostomy methods have respective advantages and disadvantages.Ileal catheter enterostomy is associated with shorter hospital stay,lower medical costs,and benefits in reducing stoma-related complications and anastomotic stricture,while its stability and long-term efficacy are inferior to those of conventional enterostomy.

Key words: low rectal cancer, sphincter-preserving surgery, prophylactic ileostomy, complications, clinical choice