留置肛管预防直肠癌术后吻合口漏的临床研究

Indwelling anal tube prevents postoperative anastomotic leakage in colorectal cancer patientsundergoing Dixon procedure

目的观察腹腔镜下直肠癌切除术后是否留置肛管与吻合口漏的关系。方法选择2015年6月至2017年6月吉林大学第二医院收治的行腹腔镜下直肠癌根治术并且吻合口距齿状线在4Cnl以内的71例患者，随机分为研究组39例，常规留置肛管；对照组32例，未留置肛管。术后1周内，连续观察两组患者术后直肠内压力变化、排便及吻合口漏发生的情况。结果研究组术后2h、1、2、3、4、5、6、7d直肠内压力分别为（13±3）、（8±3）、（11±2）、（14±4）、（16±3）、（19±2）、（21±3）、（22±3）emH2O3，对照组分别为（17±2）、（11±3）、（15±3）、（17±3）、（20±2）、（22±3）、（25±4）、（26±2）emil，0，研究组术后1周内各时间点直肠内压力均低于对照组，差异均有统计学意义（均P〈0．05）：研究组较对照组术后排气和排便时间平均提前1—2d；研究组未出现吻合口漏，对照组出现4例，发生率为12％，两组相比差异有统计学意义（P〈0．05）。结论直肠癌术后常规留置肛管能有效预防吻合漏的发生。

Objective To evaluate an indwelling anal tube in the prevention of anastomotic leakage after laparoscopie Dixon procedure for rectal cancer. Methods From June 2015 to June 2017, 71 rectal cancer patients undergoing laparoscopic Dixon procedure with the anastomotic margin to dentate line 〈 4 cm were randomly divided into the study group （39 cases） to have an anal tube dranage and the control group （32 cases） without tube dranage. Within a week after surgery, the postoperative pressure changes in the rectum, defecation, anastomotic leakeage were monitored and observed. Results In study group postoperative intra rectal pressure at 2 h, and on days 1, 2, 3, 4, 5, 6, 7 were （ 13 ± 3 ）, （8 ± 3）, （ 11 ± 2） ,（14±4） ,（16 ±3）, （19 ±2）, （21 ±3）, （22 ±3） cmH20, while in control group were （17 ±2）, （11±3）,（15±3）, （17 ±3）, （20 ±2）, （22 ±3）, （25 ±4）, （26±2）cmH20 （allP〈 0.05）. In the study group the postoperative discharge and defecation were 1 - 2 days earlier than the control group. No anastomotic leakage occurred in study group, while in control group, there were 4 cases with the incidence rate of 12% , and the difference between the two groups was statistically significant （ all P 〈 0. 05 ） . Conclusion In Dixon procedure, routinely placed anal tube effectively prevent anastomotic leakage from occurring.