腹腔镜结直肠癌根治术行腹膜内吻合后预防性放置腹腔引流管的临床效果

Clinical effect of prophylactic placement of peritoneal drainage tube in laparoscopic radical resection of colorectal cancer following intraperitoneal anastomosis

目的探讨腹腔镜结直肠癌根治术行腹膜内吻合后预防性放置腹腔引流管的临床效果。方法回顾性分析97例择期行腹腔镜下结直肠癌根治术,且术中行腹膜内吻合的患者的临床资料,按术后是否放置腹腔引流管分成引流管组58例与无引流管组39例。引流管组患者术后常规放置腹腔引流管,无引流管组不放置引流管。比较两组患者术后首次排气时间、术后住院时间及吻合口瘘、腹腔脓肿或感染、肠梗阻、切口不良、乳糜瘘、肺部感染等的发生率,以及术后1~4 d的疼痛视觉模拟量表(VAS)评分。结果两组患者均未出现吻合口瘘及死亡病例,术后住院时间及腹腔脓肿或感染、肠梗阻、切口不良、乳糜瘘、肺部感染等的发生率比较,差异均无统计学意义(均P>0.05),而引流管组术后首次排气时间长于无引流管组,术后1~4 d的VAS评分均高于无引流管组(均P<0.05)。结论腹腔镜结直肠癌根治术行腹膜内吻合后预防性放置腹腔引流管会增加患者术后疼痛,延长排气时间。

Objective To explore the clinical effect of prophylactic placement of peritoneal drainage tube in laparoscopic radical resection of colorectal cancer following intraperitoneal anastomosis. Methods The clinical data of 97 patients scheduled for laparoscopic radical resection of colorectal cancer as well as intraoperative intraperitoneal anastomosis were analyzed retrospectively, patients were divided into drainage tube group(n=58) and non-drainage tube group(n=39) according to the presence of abdominal drainage tube placement. Patients in the drainage tube group were placed peritoneal drainage tube routinely after operation, while patients in the non-drainage tube group did not receive drainage tube placement. The first postoperative exhaust time, postoperative hospital stay, incidence rates of anastomotic leakage, abdominal abscess or infection, intestinal obstruction, poor incision, chylous fistula and pulmonary infection, as well as the Visual Analogue Scale(VAS) pain scores on day 1 through day 4 postoperatively were compared between the two groups. Results There were no anastomotic leakage or death cases in the two groups, no statistically significant difference was observed between the two groups in postoperative hospital stay, or incidence rate of abdominal abscess or infection, intestinal obstruction, poor incision, chylous fistula or pulmonary infection(all P>0.05), moreover, the drainage tube group exhibited longer postoperative first exhaust time and higher VAS scores on day 1 through day 4 after operation as compared with the non-drainage tube group(all P<0.05). Conclusion Prophylactic placement of peritoneal drainage tube postoperatively might increase patients’ postoperative pain and exhaust time in laparoscopic radical resection of colorectal cancer following intraperitoneal anastomosis.