Ito Tetsuo, Obama Kazutaka, Sato Teruyuki, Matsuo Koichi, Inoue Hidenobu, Kubota Keiko, Tamaki Nobuyuki, Kami Kazuhiro, Yoshimura Naoki, Shono Takahito, Yamamoto Eiji, Morimoto Taisuke
Department of Surgery, Kyoto City Hospital, Kyoto, Japan.
Asian J Endosc Surg. 2017 Feb;10(1):17-22. doi: 10.1111/ases.12310. Epub 2016 Jul 26.
Anastomotic leakage (AL) is a major complication of laparoscopic low anterior resection (LLAR) for rectal cancer. Although several recent reports have suggested that transanal tube placement can prevent AL, this practice is still controversial. Additionally, the mechanism by which a transanal tube prevents AL is unknown. The aim of this study was to evaluate the efficacy of transanal tube placement for prevention of AL following LLAR.
This was a retrospective study that included 69 patients who underwent LLAR between February 2012 and January 2016. After an anastomosis using a double stapling technique, a transanal tube was placed in 28 patients. A diverting stoma was created in 26 patients. Univariate and multivariate analyses of clinicopathological characteristics were performed.
The overall incidence of AL was 15.9% (11/69). Univariate analysis showed that transanal tube placement (P = 0.022) and early postoperative diarrhea (P < 0.001) were associated with AL. The duration of the postoperative hospital stay for patients with transanal tube placement (13.1 ± 4.1 days) was significantly shorter than for patients without a transanal tube (22.7 ± 12.3 days; P < 0.001). However, transanal tube placement did not reduce postoperative diarrhea. Creation of a diverting stoma did not affect the incidence of AL. Multivariate analysis revealed that the absence of a transanal tube (odds ratio = 33.5, P = 0.018) and the occurrence of postoperative diarrhea (odds ratio = 86.3, P = 0.001) were independent risk factors for AL.
Transanal tube placement prevents AL after LLAR. Furthermore, this protective effect may be due to a reduction in the unfavorable incidence of early postoperative diarrhea.
吻合口漏（AL）是直肠癌腹腔镜低位前切除术（LLAR）的主要并发症。尽管最近有几份报告表明经肛门放置引流管可预防AL，但这种做法仍存在争议。此外，经肛门引流管预防AL的机制尚不清楚。本研究的目的是评估经肛门放置引流管预防LLAR术后AL的疗效。
这是一项回顾性研究，纳入了2012年2月至2016年1月期间接受LLAR的69例患者。采用双吻合器技术进行吻合后，28例患者放置了经肛门引流管。26例患者行造口转流术。对临床病理特征进行单因素和多因素分析。
AL的总发生率为15.9%（11/69）。单因素分析显示，经肛门放置引流管（P = 0.022）和术后早期腹泻（P < 0.001）与AL相关。放置经肛门引流管的患者术后住院时间（13.1±4.1天）明显短于未放置经肛门引流管的患者（22.7±12.3天；P < 0.001）。然而，经肛门放置引流管并未减少术后腹泻。造口转流术对AL的发生率没有影响。多因素分析显示，未放置经肛门引流管（比值比 = 33.5，P = 0.018）和术后腹泻的发生（比值比 = 86.3，P = 0.001）是AL的独立危险因素。
经肛门放置引流管可预防LLAR术后的AL。此外，这种保护作用可能是由于术后早期腹泻的不良发生率降低。
