双管引流在低位直肠前切除术中的应用初探

A preliminary report on double tube drainage for low anterior rectal resection

目的:探讨双管引流(末端回肠置管外引流及肛管引流)在合并吻合口漏高危因素的低位直肠前切除术中的应用价值。方法:回顾性分析2020年5月至2021年2月,收治于蚌埠医学院第一附属医院胃肠外科合并有吻合口漏高危因素且顺利施行腹腔镜低位直肠前切除术的直肠癌患者资料。患者中观察组27例,行腹腔镜低位直肠前切除术,术中加行双管引流;对照组29例,行腹腔镜低位直肠前切除+预防性末端回肠造口术。对比分析两组患者的基线情况,以手术时间,术后排气时间、进食时间,术后住院时长、并发症发生率等作为术后评价指标,比较两种手术方式的优劣,探讨双管引流用于替代末端回肠造口的安全性及可行性。结果:两组患者均手术过程顺利,术前基线对比差异无统计学意义(P值均>0.05);观察组手术时间为(146.92±19.85)min,较对照组(123.44±10.41)min延长(P<0.05);两组患者在术后排气、进食时间(2.41±0.52 d∶2.78±0.66 d)、术后住院时长(7.65±2.57 d∶7.59±1.83 d)及术后并发症发生率(18.52%∶17.24%)、术后疼痛不适等指标对比中,差异均无统计学意义(P>0.05)。结论:双管引流安全可靠,可期替代预防性造口用于治疗合并有吻合口漏高危因素的低位直肠癌患者。

Objective:To investigate the application value of double tube drainage(external drainage of terminal ileum and anal tube drainage)in low anterior rectal resection with high risk factors of anastomotic leak.Methods:The data of rectal cancer patients who were admitted to the gastrointestinal surgery from May 2020 to February 2021 with high risk factors of anastomotic leak and successfully underwent laparoscopic low anterior rectal resection were retrospectively analyzed.Among these cases,27 cases in the observation group underwent laparoscopic low anterior rectal resection with double tube drainage;in the control group,29 cases underwent laparoscopic low anterior rectal resection and prophylactic terminal ileostomy.The baseline conditions of the two groups were compared and analyzed;the time required for operation,postoperative exhaust time,eating time,postoperative hospitalization time and complication rate were used as evaluation indexes to compare the advantages and disadvantages of the two surgical methods,and to explore the safety and feasibility of double tube drainage instead of prophylactic ileostomy.Results:All patients in the two groups had a smooth operation process,and there was no significant difference in preoperative baseline(all P values>0.05).The operation time in the observation group(146.92±19.85min)was longer than that in the control group(123.44±10.41min)(P<0.05).There was no significant difference in postoperative exhaust,eating time(2.41±0.52d:2.78±0.66d),postoperative hospitalization time(7.65±2.57d:7.59±1.83d),complication rate(18.52%:17.24%),and postoperative pain and discomfort between the two groups(P>0.05).Conclusion:Double tube drainage is safe and reliable.It is hopeful to replace prophylactic terminal ileostomy in the treatment of low rectal cancer with high risk factors of anastomotic leak.