三管冲洗引流在预防直肠癌TME术后吻合口瘘中的应用

Application of three tubes for lavage and drainage in prophylaxis of anastomotic leakage following total mesorectal excision for rectal cancer

目的探讨三管冲洗引流减压对预防行直肠癌全直肠系膜切除术(TME)术后吻合口瘘发生的意义。方法将南京军区福州总医院普外研究所3年间收治的332例TME术患者随机分为A,B两组,每组166例。A组放置自制三管行冲洗引流;B组用常规引流,两组引流管均置于直肠内吻合口上5 cm处。观察两组肛管直肠压力的变化及瘘的发生率。结果术后第4天肛管直肠压力最高。A组术后均未发生吻合口瘘,B组术后发生吻合口瘘11例(6.62%,11/166),术后第4天瘘发生的例数最多,两组间差异具有统计学意义(χ2=11.389,P=0.001)。B组吻合口瘘中9例经非手术治疗痊愈,2例行近端肠造瘘转流术治愈。两组均无无围手术期死亡。结论三管冲洗引流减压能有效地预防TME术后吻合口瘘的发生。

Objective To assess the effectiveness of three tubes for lavage,drainage and decompression on prevention of anastomotic leakage after total mesorectal excision（TME） for rectal cancer. Methods Three hundred and thirty-two consecutive patients,who underwent TME for rectal cancer in the research institute of general surgery of Fuzhou general hospital of Nanjing military command,were randomly assigned into group A and B with 166 cases each.Patients of group A received the self-designed three tubes for lavage and drainage,while those of group B received the conventional drainage,and the drainage tubes were placed 5-cm above the rectal anastomotic stoma in all patients.The alterations in anorectal pressure and the incidence of anastomotic leakage of the two groups were observed. Results The anorectal pressure reached the maximum level at the fourth postoperative day.No anastomotic leakage occurred in group A,while 11 cases in group B（6.62%,11/166） developed anastomotic leakages that mostly occurred at the fourth postoperative day,and this showed a significant difference between the two groups（χ2=11.389,P=0.001）.In group B,9 cases of anastomotic leakage were cured by nonsurgical treatment and the other 2 cases resolved by proximal bypass enterostomy.No perioperative death occurred in the two groups. Conclusions The three tubes for lavage,drainage and decompression are effective in prevention of anastomotic leakage after TME for rectal cancer.