Service de Chirurgie Colorectale, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, 100 Boulevard du Général Leclerc, 92118, Clichy Cedex, France.
Tech Coloproctol. 2020 Oct;24(10):1047-1053. doi: 10.1007/s10151-020-02265-y. Epub 2020 Jun 24.
The aim of this study was to assess the effect of transanal drainage (TD) tube (a Foley catheter) on the anastomotic leak (AL) rate after laparoscopic sphincter-saving surgery for rectal cancer (SSS).
A prospective study was conducted on, all consecutive patients undergoing SSS at our institution between June 2017 and October 2018. All patients had TD for at least 4 days after surgery and constituted the TD group. The patients from TD group were matched to patients who underwent SSS without TD between January 2015 and May 2017 (no-TD group) according to age, sex, body mass index, neoadjuvant radiochemotherapy, mesorectal excision (total vs partial), and type of anastomosis (stapled vs hand sewn and side-to-end versus end-to-end). The primary endpoint was the AL rate, including both clinical and radiological AL.
A total of 258 patients were included. Eighty-nine patients (34%) had a TD tube. After matching, 72 patients were included in each group. Mean TD duration was 3.9 [2.0-5.9] days. No significant differences between groups were observed in the rates of overall AL: 25/72 (35%) (TD) vs 17/72 (22%) (no-TD), (p = 0.14), clinical AL: 13/72 (18%) (TD) vs 7/72 (10%) (no-TD), (p = 0.23), and asymptomatic radiological AL: 12/72 (17%) (TD) vs 9/72 (13%) (no-TD), (p = 0.64). Multivariate analysis showed that male sex (OR 2.92, 95% CI [1.04-8.24]) and preoperative radiochemotherapy (OR 5.66, 95% CI [1.36-23.53]) were associated with AL.
Our case-matched study suggested that a TD tube does not reduce the AL rate after laparoscopic sphincter-saving surgery for rectal cancer.
本研究旨在评估经肛门引流（TD）管（ Foley 导管）对腹腔镜保肛直肠肿瘤（SSS）术后吻合口漏（AL）发生率的影响。
本前瞻性研究纳入 2017 年 6 月至 2018 年 10 月期间在我院接受 SSS 的所有连续患者。所有患者术后至少接受 TD 管治疗 4 天，纳入 TD 组。TD 组患者根据年龄、性别、体重指数、新辅助放化疗、直肠系膜切除（完全与部分）和吻合类型（吻合器与手工缝合，端侧与端端）与 2015 年 1 月至 2017 年 5 月期间未接受 TD 管治疗的 SSS 患者（无 TD 组）进行匹配。主要终点为 AL 发生率，包括临床和影像学 AL。
共纳入 258 例患者。89 例（34%）患者置管 TD 管。匹配后，每组纳入 72 例患者。TD 管使用时间平均为 3.9[2.0-5.9]天。两组总体 AL 发生率无显著差异：TD 组 25/72（35%） vs 无 TD 组 17/72（22%）（p=0.14），临床 AL 发生率：TD 组 13/72（18%） vs 无 TD 组 7/72（10%）（p=0.23），无症状影像学 AL 发生率：TD 组 12/72（17%） vs 无 TD 组 9/72（13%）（p=0.64）。多因素分析显示，男性（OR 2.92，95%CI[1.04-8.24]）和术前放化疗（OR 5.66，95%CI[1.36-23.53]）与 AL 相关。
本病例匹配研究表明，经肛门引流管不能降低腹腔镜保肛直肠肿瘤术后的 AL 发生率。
