Department of General Surgery, First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China.
School of Medicine, Southeast University, Nanjing, China.
Colorectal Dis. 2022 Nov;24(11):1273-1284. doi: 10.1111/codi.16231. Epub 2022 Jul 20.
The aim was to evaluate the efficacy of transanal drainage tube (TDT) placement for preventing anastomotic leakage after low anterior resection for rectal cancer.
PubMed, the Cochrane Central Register of Controlled Trials, Embase and ClinicalTrials.gov databases were searched up to October 2021. Studies comparing outcomes following low anterior resection with or without TDT were included. The primary outcomes measured were anastomotic leakage rate, reoperation rate and anastomotic bleed rate.
Three randomized controlled trials (RCTs) and 16 observational studies (prospective or retrospective) involving 4560 patients satisfied the basic inclusion criteria. In RCTs, a TDT was associated with no statistically significant differences in anastomotic leakage (OR = 0.67, 95% CI 0.42-1.05, P = 0.08), reduction in reoperation (OR = 0.11, 95% CI 0.03-0.51, P = 0.004) and increased anastomotic bleeding rate (OR = 2.36, 95% CI 1.11-5.01, P = 0.03). In observational studies, a TDT was associated with significant reduction in anastomotic leak (OR = 0.44, 95% CI 0.30-0.64, P < 0.0001) and reoperation (OR = 0.47, 95% CI 0.33-0.69, P < 0.0001), with no statistically significant differences in anastomotic bleeding (OR = 1.30, 95% CI 0.20-8.30, P = 0.78).
In RCTs, a TDT for rectal cancer was correlated with no detectable differences in anastomotic leakage and with an increased risk of anastomotic bleeding. In observational studies, a TDT was correlated with reduction in anastomotic leakage and no detectable differences in anastomotic bleeding. Both RCTs and observational studies demonstrated a comparable reduction in reoperation rate with TDT. These data in aggregate indicated that TDTs may not show superiority but emphasized differences between RCT and observational data.
评估经肛门引流管（TDT）放置预防低位前切除术后吻合口漏的疗效。
检索了 PubMed、Cochrane 中心对照试验注册库、Embase 和 ClinicalTrials.gov 数据库，截至 2021 年 10 月。纳入比较低位前切除术后使用或不使用 TDT 的患者结局的研究。主要结局指标为吻合口漏发生率、再次手术率和吻合口出血率。
符合基本纳入标准的 3 项随机对照试验（RCT）和 16 项观察性研究（前瞻性或回顾性）共纳入 4560 例患者。在 RCT 中，TDT 与吻合口漏（OR=0.67，95%CI 0.42-1.05，P=0.08）、减少再次手术（OR=0.11，95%CI 0.03-0.51，P=0.004）和增加吻合口出血率（OR=2.36，95%CI 1.11-5.01，P=0.03）无统计学显著差异。在观察性研究中，TDT 与吻合口漏（OR=0.44，95%CI 0.30-0.64，P<0.0001）和再次手术（OR=0.47，95%CI 0.33-0.69，P<0.0001）显著减少相关，而吻合口出血无统计学显著差异（OR=1.30，95%CI 0.20-8.30，P=0.78）。
在 RCT 中，TDT 治疗直肠癌与吻合口漏无显著差异相关，且吻合口出血风险增加。在观察性研究中，TDT 与吻合口漏减少相关，吻合口出血无显著差异。RCT 和观察性研究均显示 TDT 可降低再次手术率。这些数据综合表明，TDT 可能没有优势，但强调了 RCT 和观察性数据之间的差异。
