内镜下真空治疗联合经肛引流在直肠前切除术后吻合口漏中的长期疗效
Long-term Outcomes of Endoscopic Vacuum Therapy and Transanal Drainage for Anastomotic Leakage After Anterior Resection.
机构信息
Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Department of Surgery, Skåne University Hospital, Malmö, Sweden.
出版信息
In Vivo. 2022 Sep-Oct;36(5):2275-2278. doi: 10.21873/invivo.12956.
BACKGROUND/AIM: Anastomotic leakage (AL) after anterior resection for rectal cancer occurs in up to 26% of patients. In the last decade, endoscopic vacuum therapy (EVT) has gained interest as a treatment option for AL. This study aimed to compare the clinical success rate of EVT versus transanal drainage (TD) in AL treatment and investigate whether the frequency of bowel continuity differed.
PATIENTS AND METHODS
Patients treated for rectal cancer at the Skåne University Hospital, Sweden between 2009-2018 were identified through the Swedish Colorectal Cancer Registry (SCRCR). Patient characteristics, operative and AL data were retrieved by SCRCR and chart review.
RESULTS
Out of 1,095 patients subjected to rectal cancer surgery, 361 patients had undergone anterior resection. AL occurred in 39 patients, of these 14 patients were treated with EVT and 17 with TD. Bowel continuity was achieved in 50% of patients treated with EVT and 65% of patients treated with TD (p=0.28). The patients were under treatment for a median period of 24.5 days (IQR=11-36 days) when treated with EVT and 37 days (IQR=17-51 days) with TD.
CONCLUSION
No superiority of EVT treatment could be shown in restoring bowel continuity. This questions the role of EVT in AL treatment after anterior resection.
背景/目的：直肠癌前切除术术后吻合口漏（AL）的发生率高达 26%。在过去十年中，内镜下真空治疗（EVT）作为 AL 的治疗选择引起了关注。本研究旨在比较 EVT 与经肛门引流（TD）治疗 AL 的临床成功率，并探讨肠连续性的差异。
患者和方法
通过瑞典结直肠癌登记处（SCRCR），确定了 2009 年至 2018 年在瑞典斯科讷大学医院接受直肠癌治疗的患者。通过 SCRCR 和病历回顾，获取患者特征、手术和 AL 数据。
结果
在 1095 例接受直肠癌手术的患者中，361 例接受了前切除术。39 例发生 AL，其中 14 例接受 EVT 治疗，17 例接受 TD 治疗。EVT 治疗的患者中有 50%恢复了肠连续性，TD 治疗的患者中有 65%（p=0.28）。EVT 治疗的患者中位治疗时间为 24.5 天（IQR=11-36 天），TD 治疗的患者中位治疗时间为 37 天（IQR=17-51 天）。
结论
EVT 治疗在恢复肠连续性方面没有优势。这质疑了 EVT 在直肠癌前切除术后 AL 治疗中的作用。
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