Nishigori Hideaki, Ito Masaaki, Nishizawa Yuji, Nishizawa Yusuke, Kobayashi Akihiro, Sugito Masanori, Saito Norio
Colorectal and Pelvic Surgery Division, Department of Surgical Oncology, National Cancer Center Hospital East, Kashiwanoha 6-5-1, Kashiwa, Chiba, 277-8577, Japan,
World J Surg. 2014 Jul;38(7):1843-51. doi: 10.1007/s00268-013-2428-4.
We evaluated the effectiveness and safety of a transanal tube placed for the prevention of anastomotic leakage after rectal surgery.
Between 2007 and 2011, a total of 243 patients underwent anterior resection using the double stapling technique for rectal cancer at our institution. We excluded 67 patients with diverting stoma and divided the remaining patients into two groups: patients who did not receive a transanal tube and diverting stoma (n = 140; control group) and those who received a transanal tube (n = 36). We compared the rate of anastomotic leakage, evaluated the complications associated with the transanal tube, and analyzed the risk factors for anastomotic leakage.
The following perioperative parameters were significantly different between the two groups as follows (control group vs. transanal tube group): diabetes mellitus (8 [22 %] vs. 12 [8.5 %] patients, respectively; p = 0.03), surgical duration (262 ± 54.1 min [171-457] vs. 233 ± 61.7 min [126-430], respectively; p < 0.01). The postoperative anastomosis leakage appeared significantly different between the two groups (1 [2.7 %] vs. 22 [15.7 %] patients, respectively; p = 0.04). Anastomotic leakage was significantly associated with the distance between the anastomosis line and the anal verge (odds ratio [OR] 8.58; 95 % confidence interval [CI] 1.53-48.0; p = 0.01) and non-use of a transanal tube (OR 11.1; 95 % CI 1.04-118; p = 0.04) in both univariate and multivariate analyses.
Placement of a transanal tube is effective in decreasing the rate of anastomotic leakage after anterior resection using the double stapling technique. However, complications associated with a transanal tube should be carefully considered.
我们评估了经肛门放置的肛管预防直肠手术后吻合口漏的有效性和安全性。
2007年至2011年期间，我院共有243例患者采用双吻合器技术行直肠癌前切除术。我们排除了67例有转流造口的患者，并将其余患者分为两组：未接受经肛门肛管和转流造口的患者（n = 140；对照组）和接受经肛门肛管的患者（n = 36）。我们比较了吻合口漏的发生率，评估了与经肛门肛管相关的并发症，并分析了吻合口漏的危险因素。
两组间以下围手术期参数存在显著差异（对照组 vs. 经肛门肛管组）：糖尿病（分别为8例[22%] vs. 12例[8.5%]患者；p = 0.03），手术时间（分别为262±54.1分钟[171 - 457] vs. 233±61.7分钟[126 - 430]；p < 0.01）。两组术后吻合口漏情况存在显著差异（分别为1例[2.7%] vs. 22例[15.7%]患者；p = 0.04）。在单因素和多因素分析中，吻合口漏与吻合口线至肛缘的距离（比值比[OR] 8.58；95%置信区间[CI] 1.53 - 48.0；p = 0.01）及未使用经肛门肛管（OR 11.1；95% CI 1.04 - 118；p = 0.04）显著相关。
采用双吻合器技术行前切除术后，放置经肛门肛管可有效降低吻合口漏的发生率。然而，应仔细考虑与经肛门肛管相关的并发症。
