经肛粪便导流技术预防中低位直肠癌术后吻合口漏的回顾性临床研究

Prevention of anastomotic leakage after operation for middle-low rectal cancer by fecal drainage on rectal anastomosis:a retrospective clinical study

目的评估经肛粪便导流技术预防中低位直肠癌术后吻合口漏的有效性、安全性及可行性。方法回顾性收集2014–2019年期间在我院完成的中低位直肠癌手术患者,按采用预防吻合口漏方式分为经肛粪便导流组(粪便导流组)和末端回肠预防性造口组(回肠造口组),比较2组患者术后吻合口漏发生率及漏后处置方式及转归。结果共纳入患者231例,其中粪便导流组84例,回肠造口组147例,2组患者性别、年龄、术前合并症等基线资料比较差异无统计学意义(P>0.050)。2组患者手术时间、术中失血量、切口感染、术后肠梗阻、总住院费用、死亡情况、吻合口漏(总体、各分级、处理方式及结局)比较差异均无统计学意义(P>0.050)。虽然粪便导流组的住院时间(除外漏病例)明显长于回肠造口组(P<0.001),但2组患者总住院时间和排除死亡病例后的住院时间比较差异无统计学意义(P>0.050),且粪便导流组的吻合口漏愈合后吻合口狭窄发生率低于回肠造口组(P=0.029)。结论经肛粪便导流技术在预防中低位直肠癌保肛手术吻合口漏的发生的安全、有效、可行的。

Objective To evaluate the efficacy,safety,and feasibility of fecal drainage technique on rectal anastomosis for preventing anastomotic leakage after operation for middle-low rectal cancer.Methods The retrospective analysis was used to collect the middle-low rectal cancer which completed operation in this hospital from 2014 to 2019.According to the way of preventing annstomotic leakage,the patients were divided into two groups:fecal drainage on rectal anastomosis group(Abbreviation:fecal drainage group)and end ileum prophylactic stoma group(Abbreviation:ileostomy group).The incidence of anastomotic leakage after operation and the different treatment methods following leakage were compared between the two groups.Results A total of 231 cases were recorded,including 84 cases in the fecal drainage group,147 cases in the ileostomy group.There were no significant differences in the baseline data such as the gender,age,preoperative complications,operation mode,etc.between the two groups(P>0.050).There were no significant differences in the operation time,intraoperative blood loss,incision infection,postoperative intestinal obstruction,total hospitalization cost,death,anastomotic leakage(overall,each grade,treatment,and outcome)between the two groups(P>0.050).Although the length of hospital stay except the patients with anastomotic leakage in the fecal drainage group was significantly longer than that in the ileostomy group(P<0.001),there was no significant difference in the total length of hospital stay between the two groups(P>0.050),and the incidence of anastomotic stenosis in the fecal drainage group was significantly lower than that in the ileostomy group(P=0.029).Conclusion According to the results of this study,fecal drainage technique on rectal anastomosis is effective,safe,and feasible in preventing anastomotic leakage after operation for middle-low rectal cancer.