关键词: 末端回肠插管造口, 吻合口漏, 术后并发症

Abstract: Objective To investigate the effect of a new balloon catheter modified by the author in the protection of rectal anastomosis with high risk factors in Transcecum tube ileostomy(TTI).Method From December 2019 to December 2021, 61 patients underwent prophylactic ostomy due to high risk factors of anastomosis after surgical resection of colorectal malignant tumor in our hospital.According to the different way of colostomy into the cecum terminal ileum intubation colostomy groups(TTI,29 cases) and traditional end ileostomy group(Loop ileostomy,32 cases).The gender,age,preoperative comorbidities,distance between tumor and anal margin,operation time,stoma operation time,postoperative anastomose-related complications,postoperative stoma/stoma tube drainage volume,stoma/stoma tube related complications,hospitalization costs and other related indicators were compared and analyzed between the two groups.Results The operation time of TTI group and LI group were (16.31±2.64)min and (27.84±4.85)min,respectively,and the operation cost was (4.84±0.50)thousand yuan and (5.85±1.19)thousand yuan,respectively.In LI group,the incidences of ostomy/ostomy tube related complications were 34% and 6%,respectively,and the difference was statistically significant(P<0.05).In the TTI group,there were no reoperation cases,while in the LI group,18 cases were reoperation,including 1 case of stoma reconstruction and the rest of them were ostomy reduction.The incidence of complications after reoperation was 55.56%(10/18),and disuse enteritis was the most common,and one case of ISREC grade B leakage was found,which was cured by symptomatic treatment such as fasting water and nutritional support.There were significant differences in reoperation rate and complication rate between the two groups(P < 0.05).There were 2 cases of ISREC grade A leakage in both groups,and 1 case of anastomotic stenosis in the LI group,which was improved after 2 weeks of continuous expansion.There was no significant difference in the incidence of anastomotic complications between the two groups(P>0.05).There were no significant differences in operation time,blood loss,distance between anastomosis and anal margin,postoperative hospital stay,tumor size,and daily drainage volume of stoma/stoma tube(P>0.05).Conclusion This new modified balloon catheter is safe and reliable for TTI surgery.It has similar effect to traditional terminal ileostomy in protecting rectal anastomosis with high risk factors,but has fewer complications and the operation is simple.

Key words: transcecum tube ileostomy, anastomotic leakage, postoperative complications