Zhao Song, Tong Weidong
Department of Gastric and Colorectal Surgery, Daping Hospital, Institute of Surgery Research, the Third Military Medical University, Chongqing 400042, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Jun;19(6):714-7.
Anastomotic leakage (AL) is one of the most serious complications of anterior resection for rectal cancer with morbidity about 10%. Distance of anastomosis to anal margin, underlying disease, surgical technique and perioperative situations are associated with AL. The transanal drainage tube (TDT) after anastomosis is gradually proved to be useful in prevention of AL. Most of the literatures suggest that TDT is simple and safe, and can reduce the incidence of AL. The materials and the operating process of TDT have been universalized gradually: application of silicone or rubber material, large lumen with several side holes, placement at a distance of 3 to 5 cm above the anastomosis for 5 to 7 days. However, selection bias existed in previous studies, and the main problems were disunity of enrolling standard and exclusion of patients with high AL risk, which would not fully reflect the value of TDT. Defunctioning stoma (or diverting stoma, DS) is a common method to prevent and treat the AL. At present, efficacy comparison between TDT and DS remains controversial. Thus, randomized, double-blind, controlled trials are needed to investigate the value of TDT in prevention of AL after anterior resection, especially for middle and low rectal cancer.
吻合口漏（AL）是直肠癌前切除术最严重的并发症之一，发病率约为10%。吻合口至肛缘的距离、基础疾病、手术技术和围手术期情况均与吻合口漏相关。吻合术后经肛门引流管（TDT）逐渐被证明对预防吻合口漏有用。大多数文献表明，经肛门引流管操作简单且安全，可降低吻合口漏的发生率。经肛门引流管的材料和操作过程已逐渐普及：采用硅胶或橡胶材料，大口径且带有多个侧孔，置于吻合口上方3至5厘米处，放置5至7天。然而，既往研究存在选择偏倚，主要问题是纳入标准不统一以及排除了吻合口漏高风险患者，这无法充分反映经肛门引流管的价值。去功能化造口（或转流造口，DS）是预防和治疗吻合口漏的常用方法。目前，经肛门引流管与去功能化造口的疗效比较仍存在争议。因此，需要进行随机、双盲、对照试验来研究经肛门引流管在直肠癌前切除术后预防吻合口漏中的价值，尤其是对于中低位直肠癌。
