经肛门引流管在预防腹腔镜低位直肠癌前切除术后吻合口漏中的有效性。
Effectiveness of a Transanal Drainage Tube for the Prevention of Anastomotic Leakage after Laparoscopic Low Anterior Resection for Rectal Cancer.
机构信息
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
出版信息
Asian Pac J Cancer Prev. 2020 May 1;21(5):1441-1444. doi: 10.31557/APJCP.2020.21.5.1441.
BACKGROUND AND OBJECTIVE
Anastomotic leakage is one of the most serious complications after laparoscopic low anterior resection Low Anterior Resection (LAR) for rectal cancers. The purpose of this study was to evaluate the effectiveness of a transanal drainage tube placed for the prevention of anastomotic leakage after laparoscopic LAR.
METHODS
The clinical data of 220 patients with rectal cancer who underwent laparoscopic LAR using the double stapling technique Double Stapling Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Technique (DST) from Jun 2017 to Dec 2018 were analyzed retrospectively at our institution. A transanal drainage tube was placed after anastomosis in 120 patients (TDT group). Another 100 patients were operated on without a transanal drainage tube (NTDT group). Clinicopathological and surgical factors, the frequencies of anastomotic leakage and re-operation after leakage were compared between the two groups.
RESULTS
Patient age, gender, body mass index, American Society of Anesthesiologists (ASA) score, previous abdominal surgery, intraoperative blood loss, tumor size, tumor stage, specimen length, distance of tumor from the anal verge, and operative time were comparable between the two groups. Overall rate of leakage was 4.5% (10/220). The frequency of leakage was 3.3% (4/120) in TDT group and was 6.0% (6/100) in NTDT group. The rate of leakage was significantly lower in TDT group (p<0.05). Furthermore, the re-operation rate for symptomatic anastomotic leakage was 50.0% (2/4) in TDT group, while in contrast it was 83.3% (5/6) in NTDT group. The rate of re-operation was lower in TDT group than NTDT group (p<0.05).
CONCLUSIONS
The use of a transanal drainage tube in laparoscopic LAR for rectal cancer is a simple and effective method for prevention of anastomotic leakage and decreases the rate of re-operation after symptomatic leakage.
背景与目的
吻合口漏是直肠癌腹腔镜低位前切除术（LAR）后最严重的并发症之一。本研究旨在评估经肛门引流管在预防腹腔镜 LAR 后吻合口漏中的效果。
方法
回顾性分析 2017 年 6 月至 2018 年 12 月期间，在我院行腹腔镜 LAR 并采用双吻合器技术（DST）的 220 例直肠癌患者的临床资料。其中 120 例患者（TDT 组）在吻合后放置经肛门引流管，100 例患者未放置经肛门引流管（NTDT 组）。比较两组患者的临床病理和手术因素、吻合口漏的发生率以及漏口后的再次手术率。
结果
两组患者的年龄、性别、体重指数、美国麻醉医师协会（ASA）评分、既往腹部手术史、术中出血量、肿瘤大小、肿瘤分期、标本长度、肿瘤距肛缘距离、手术时间等均无统计学差异。吻合口漏总发生率为 4.5%（10/220）。TDT 组的漏口发生率为 3.3%（4/120），NTDT 组为 6.0%（6/100）。TDT 组漏口发生率明显低于 NTDT 组（p<0.05）。此外，TDT 组有症状吻合口漏的再次手术率为 50.0%（2/4），而 NTDT 组为 83.3%（5/6）。TDT 组的再次手术率低于 NTDT 组（p<0.05）。
结论
在腹腔镜 LAR 治疗直肠癌中使用经肛门引流管是一种预防吻合口漏的简单有效方法，可降低有症状吻合口漏后的再次手术率。
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