Zhang C R, Xu S Y, Lv Y C, Du B B, Wu D W, Li J J, Zhu C Z, Yang X F
Department of Anorectal Surgery, Gansu Provincial People's Hospital, Lanzhou 730000, China Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou 730000, China Clinical Medical College of Ningxia Medical University, Yinchuan 750000, China.
Department of Anorectal Surgery, Gansu Provincial People's Hospital, Lanzhou 730000, China Clinical Research Center for Anorectal Diseases of Gansu Province, Lanzhou 730000, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2023 Jul 25;26(7):689-696. doi: 10.3760/cma.j.cn441530-20221125-00493.
To assess the effectiveness of transanal drainage tube (TDT) in reducing the incidence of anastomotic leak following anterior resection in patients with rectal cancer. We conducted a systematic search for relevant studies published from inception to October 2022 across multiple databases, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP. Meta-analysis was performed using Review Manager 5.4 software. The primary outcomes included total incidence of anastomotic leak, grade B and C anastomotic leak rates, reoperation rate, anastomotic bleeding rate, and overall complication rate. Three randomized controlled trials involving 1115 patients (559 patients in the TDT group and 556 in the non-TDT group) were included. Meta-analysis showed that the total incidences of anastomotic leak and of grade B anastomotic leak were 5.5% (31/559) and 4.5% (25/559), respectively, in the TDT group and 7.9% (44/556) and 3.8% (21/556), respectively, in the non-TDT group. These differences are not statistically significant (=0.120, =0.560, respectively). Compared with the non-TDT group, the TDT group had a lower incidence of grade C anastomotic leak (1.6% [7/559] vs. 4.5% [25/556]) and reoperation rate (0.9% [5/559] vs. 4.3% [24/556]), but a higher incidence of anastomotic bleeding (8.2% [23/279] vs. 3.6% [10/276]). These differences were statistically significant (=0.003, =0.001, =0.030, respectively). The overall complication rate was 26.5%(74/279) in the TDT group and 27.2% (75/276) in the non-TDT group. These differences are not statistically significant (=0.860). TDT did not significantly reduce the total incidence of anastomotic leak but may have potential clinical benefits in preventing grade C anastomotic leak. Notably, placement of TDT may increase the anastomotic bleeding rate.
评估经肛门引流管（TDT）在降低直肠癌患者前切除术后吻合口漏发生率方面的有效性。我们对从数据库建库至2022年10月期间发表的相关研究进行了系统检索，检索的数据库包括PubMed、Embase、Web of Science、Cochrane图书馆、中国知网、万方和维普。使用Review Manager 5.4软件进行荟萃分析。主要结局包括吻合口漏的总发生率、B级和C级吻合口漏发生率、再次手术率、吻合口出血率及总体并发症发生率。纳入了3项随机对照试验，共1115例患者（TDT组559例，非TDT组556例）。荟萃分析显示，TDT组吻合口漏总发生率和B级吻合口漏发生率分别为5.5%（31/559）和4.5%（25/55），非TDT组分别为7.9%（44/556）和3.8%（21/556）。这些差异无统计学意义（分别为=0.120，=0.560）。与非TDT组相比，TDT组C级吻合口漏发生率（1.6% [7/559] 对4.5% [25/556]）和再次手术率（0.9% [5/559] 对4.3% [24/556]）较低，但吻合口出血发生率较高（8.2% [23/279] 对3.6% [10/276]）。这些差异有统计学意义（分别为=0.003，=0.001，=0.03）。TDT组总体并发症发生率为26.5%（74/279），非TDT组为27.2%（75/276）。这些差异无统计学意义（=0.860）。TDT并未显著降低吻合口漏的总发生率，但在预防C级吻合口漏方面可能具有潜在的临床益处。值得注意的是，放置TDT可能会增加吻合口出血率。
