Wang Guancong, Tang Haiwen, Huang Ying, Guo Yincong
Department of Colorectal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China.
Department of Colorectal and Anal Surgery, Zhangzhou Municipal Hospital of Fujian Province, Zhangzhou, 363000, China.
Sci Rep. 2025 May 29;15(1):18834. doi: 10.1038/s41598-025-03440-7.
To assess whether transanal drainage tubes (TDT) protect against anastomotic leakage (AL) in patients without diverting stomas (DS) after laparoscopic anterior rectal resection (LAR). In the TDT group, after anastomosis of the sigmoid colon to the rectum, a 32F silicone tube was inserted through the anus with the tip of the tube exceeding the anastomosis by more than 5 cm. The tube was secured around the anus with a skin suture and a drainage bag was attached. It was left in place for 3-5 days postoperatively in the TDT group. In the No-TDT group, no transanal silicone tube drainage was used after the anastomosis. A total of 927 patients (620 in the no-TDT group and 307 in the TDT group) were included in the analysis, and a total of 50 (5.4%) patients were observed to develop AL. After using propensity score matching (PSM) to reduce baseline feature imbalances between the two groups, there were 287 patients in both groups, and the mean retention time of TDT was (4.7 ± 1.2) d. The incidence of AL in the TDT group was significantly lower than that in the no-TDT group (3.8% vs. 8.0%, with a the incidence of AL in the TDT group was significantly lower than that in the non-TDT group (3.8% vs. 8.0%, P = 0.034), but the incidence of AL classification was similar (P = 0.709). There were no significant differences between the two groups in terms of postoperative complications and postoperative recovery. Multivariate logistic regression analysis revealed that TDT was found to be an independent protective factor for postoperative AL (OR 0.437, 95% CI 0.207-0.923, P = 0.030). The elective use of TDT is a simple and effective protective measure for the prevention of AL in patients without stoma after LAR surgery, helping to reduce the probability of AL. This may be a potential alternative DS method for the appropriate population.
评估经肛门引流管（TDT）对腹腔镜直肠前切除术（LAR）后未行转流造口（DS）患者吻合口漏（AL）的预防作用。在TDT组中，乙状结肠与直肠吻合后，经肛门插入一根32F硅胶管，使管尖超过吻合口5cm以上。用皮肤缝线将管子固定在肛门周围并连接引流袋。TDT组术后留置3 - 5天。在非TDT组中，吻合术后未使用经肛门硅胶管引流。共有927例患者纳入分析（非TDT组620例，TDT组307例），共观察到50例（5.4%）患者发生AL。采用倾向评分匹配（PSM）以减少两组间基线特征不平衡后，两组各有287例患者，TDT平均留置时间为（4.7±1.2）天。TDT组AL发生率显著低于非TDT组（3.8%对8.0%，P = 0.034），但AL分级发生率相似（P = 0.709）。两组术后并发症及术后恢复情况无显著差异。多因素logistic回归分析显示，TDT是术后AL的独立保护因素（OR 0.437，95%CI 0.207 - 0.923，P = 0.030）。选择性使用TDT是LAR术后无造口患者预防AL的一种简单有效的保护措施，有助于降低AL发生概率。这可能是适合特定人群的一种潜在替代DS方法。
