Faculty of Medicine, Laval University, Quebec, Canada.
Dis Colon Rectum. 2013 May;56(5):586-92. doi: 10.1097/DCR.0b013e31827687a4.
Anastomotic leaks after low anterior resection for rectal cancer remain a major cause of morbidity and mortality. Few studies have focused on their management, particularly on the technique of transanal drainage.
The aim of this study was to assess the short- and long-term outcomes according to the initial management of clinical leaks.
This study is a retrospective review of a single institution experience.
All patients treated for a symptomatic anastomotic leak after low anterior resection for rectal cancer between January 2000 and March 2011 were included.
The primary outcomes were mortality attributed to the leak, sepsis control, stoma closure rate, and functional results.
A total of 37 patients (35 men/2 women) developed a symptomatic leak. Leaks were initially managed by transanal drainage in 16 patients, abdominal reintervention in 12 patients, and medical treatment in 9 patients. The only death attributed to the leak occurred in the abdominal reintervention group. In the transanal drainage group, antibiotics were administered for a median length of 9 days, and the drain was left in place for a median length of 30 days. One patient underwent percutaneous drainage of a collection in addition to transanal drainage, but no patient required abdominal reintervention. Of the treatment modalities applied, transanal drainage was associated with the highest stoma closure rate (93%), after a median postoperative time of 7 months. Complications observed after transanal drainage were anastomotic strictures in 33% and the creation of a permanent stoma due to poor function in 13%.
This study was limited by its nonrandomized retrospective design and the presence of selection bias.
: For the management of low anastomotic leaks, transanal drainage allows preservation of the anastomosis and sepsis control with a high rate of ileostomy closure. It is a valuable option in patients with a diverting ileostomy.
低位前切除术治疗直肠癌后的吻合口漏仍然是发病率和死亡率的主要原因。很少有研究关注其治疗方法，特别是经肛门引流的技术。
本研究旨在评估根据吻合口漏的初始治疗方法的短期和长期结果。
这是一项对单一机构经验的回顾性研究。
所有在 2000 年 1 月至 2011 年 3 月期间因低位前切除术后直肠吻合口漏而接受治疗的患者均纳入本研究。
主要结局是吻合口漏导致的死亡率、脓毒症控制、造口关闭率和功能结果。
共有 37 例（35 名男性/2 名女性）出现症状性吻合口漏。16 例患者采用经肛门引流治疗，12 例患者采用腹部再干预治疗，9 例患者采用药物治疗。唯一与漏相关的死亡发生在腹部再干预组。在经肛门引流组，抗生素治疗中位数为 9 天，引流管放置中位数为 30 天。1 例患者除经肛门引流外还进行了经皮引流，但无患者需要腹部再干预。应用的治疗方法中，经肛门引流的造口关闭率最高（93%），术后中位时间为 7 个月。经肛门引流后观察到的并发症包括吻合口狭窄（33%）和因功能不佳而永久造口（13%）。
本研究受非随机回顾性设计和存在选择偏倚的限制。
对于低位吻合口漏的治疗，经肛门引流可保留吻合口并控制脓毒症，造口关闭率高。对于有转流性回肠造口的患者，这是一种有价值的选择。
