经肛门瘘口引流治疗中低位直肠癌保肛术后吻合口瘘

Transanal drainage in treatment of anastomotic leakage after anuspreserving resection for mid/lower rectal cancer

目的:探讨经肛门瘘口引流治疗中低位直肠癌保肛术后发生吻合口瘘临床价值。方法:回顾性分析2010年1月―2013年10月间21例中低位直肠癌保肛术后发生吻合口瘘患者的临床资料,其中采用经肛门吻合口瘘口引流9例(观察组),单纯腹腔引流管冲洗引流12例(对照组),比较两组患者的相关临床指标。结果:两组患者均痊愈出院;观察组无1例须行肠造瘘,对照组有2例保守治疗效果不佳,行肠造瘘,但两组间差异无统计学意义(P=0.122);总的住院时间两组间差异无统计学意义(P=0.061),但瘘后的住院时间及医疗费用上观察组低于对照组,差异有统计学意义(P=0.012,P=0.031)。随访2个月至3年,患者术后便秘、腹泻、肛门不适感等症状发生率两组间差异无统计学意义(P=0.066)。结论:经肛门吻合口瘘口置管引流术可作为中低位直肠癌患者保肛术后吻合口瘘重要的治疗措施,具有缩短瘘后住院时间、降低住院费用、易于接受等优点。

Objective： To assess the clinical value of transanal drainage in treatment of anastomotic leakage after anus- preserving resection for mid/lower rectal cancer. Methods： The clinical data of 21 patients developing anastomotic leakage after anus-preserving resection for mid/lower rectal cancer from January 2010 to October 2013 were retrospectively analyzed. Of the patients, 9 cases received transanal drainage （observational group）, and 12 cases underwent abdominal drainage tube irrigation only （control group）, and the associated clinical parameters were compared between the two groups. Results： All patients in the two groups recovered and were discharged from the hospital. None of the patients in observational group required a colostomy, but 2 cases in control group underwent colostomy attributed to conservative treatment failure, however, the difference did not reach a statistical significance （P=0.122）. The difference in total length of hospital stay between the two groups had no statistical significance （P=0.061）, but thelength of post-fistula hospital stay and hospitalization cost in observational group were lower than those in control group, and the differences had statistical significance （P=0.012, P=0.031）. Follow-up was conducted for 2 months to 3 years, and no sta[istical difference was noted between the two groups in incidence of postoperative symptoms such as constipation, diarrhea, anal discomfort （P=0.066）. Conclusion： Transanal drainage can be used as an important method for treatment of anastomotic leakage after anus-preserving resection for mid/lower rectal cancer, which has the advantages of shortening the length of post- fistula hospital stay, reducing hospitalization cost, and high patients＇ acceptance.