双套管肛管预防腹腔镜辅助下中低位直肠癌前切除术后吻合口瘘的效果分析

Effect of Double-tube Anal Canal in Prevention of Anastomotic Fistula of Middle or Low Rectal Cancer after Laparoscopic-assisted Anterior Resection

目的探讨双套管肛管对腹腔镜辅助下中低位直肠癌前切除术后吻合口瘘的防治效果。方法采取回顾性研究方法,选取黄石市中医医院2003年10月至2015年10月共收治的658例中低位直肠癌患者(除外手术时即行预防性造瘘患者)资料,按照术后处理方法的不同分为2组,其中A组(325例)患者应用双套管肛管的处理方法,B组(333例)患者应用常规的处理方法。比较2组吻合口瘘的发生率、引流管放置时间、手术后住院时间、住院费用、2组患者出现吻合口瘘后需二次手术率以及术后半年复查出现吻合口狭窄情况。结果 658患者中出现术后吻合口瘘30例(4.6%,30/658),其中A组患者发生吻合口瘘12例(5.1%,12/325),B组发生吻合口瘘18例(5.4%,18/333),2组吻合口瘘发生率差异有统计学意义(P<0.05)。A组患者在引流管平均放置时间为(9.5±3.1)d,B组平均为(15.3±4.5)d,差异有统计学意义(P<0.05)。A组患者手术后住院时间为(15.3±5.4)d,B组为(20.4±6.7)d;A组患者住院费用为(43572±3234)元,B组为(53387±4792)元;差异均有统计学意义(P<0.05)。A组患者术后出现吻合口瘘再次手术情况有2例(2/12,16.7%),B组有12例(12/18,66.7%),差异有统计学意义(P<0.05)。A组患者术后半年复查无吻合口狭窄情况出现,B组有6例出现吻合口狭窄,通过扩肛治疗后排大便顺畅。结论使用双套管肛管联合前列地尔治疗有利于降低腹腔镜辅助下对中低位直肠癌前切除术后吻合口瘘的发生。

Objective To explore the effect of double-tube anal canal in prevention of anastomotic fistula of middle or low rectal cancer after laparoscopic-assisted anterior resection. Methods A retrospective study was conducted in 658 patients with middle or low rectal cancer（ except for prophylactic fistula during operation）. According to the postoperative treatment were divided into 2 groups,group A（ n = 325 ） were treated with double-canal anal canal and group B（ n = 333 ） were treated with con- ventional treatment. The incidence rate of anastomotic fistula, drainage tube placement time, hospital stay and hospitalization cost were compared between the 2 groups. Anastomotic stenosis was observed in the 2 groups after operation. Results There were 30 （4.6% ,30/658） cases of postoperative anastomotic fistula in 658 patients, 12 cases （5. 1%, 12/325 ） in group A, 18 cases （ 5.4% , 18/333 ） in group B, and the occurrence of anastomotic fistula of the 2 groups had significant difference （ P 〈 0.05 ）. The average time of drainage tube in group A was （9.5 ± 5.1 ） d, in group B was （ 15.3 ± 4.5 ） d, the difference was statistically signifi- cant （P 〈0. 05 ） ;The hospitalization time in group A was （15.3 ±5.4） d and in group B was （20.4 ± 6.7 ） d;the hospitalization cost in group A was （43572 ± 3234 ） and in group B was （53387 ± 4792 ） , the difference was statistically significant （P 〈 0. 05 ）. There were 2 cases（2/12,16.7% ） of reoperation in group A, and 12 cases（ 12/18,66.7% ） in group B, the difference was sta- tistically significant（ P 〈 0.05 ）. In group A, there was no anastomotic stenosis in 6 months after operation. In group B, there was 6 cases of anastomotic stenosis in 6 months after operation. Conclusion Double-tube anal canal for middle or low rectal cancer af- ter laparoscopic-assisted anterior resection can reduce anastomotic fistula.