留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究

Effect of indwelling anal tube on anastomotic leakage after laparoscopic total mesangectomy after neoadjuvant chemoradiotherapy in patients with middle and low rectal cancer

目的研究留置肛管在中低位直肠癌新辅助放化疗(nCRT)后腹腔镜全直肠系膜切除术(TME)中的临床研究。方法回顾性分析2019年1月至2022年12月80例中低位直肠癌患者的临床资料,所有患者术前均接受nCRT后行腹腔镜TME,将术后留置肛管的46例患者作为留置组,将34例术后未留置肛管的患者作为传统组。数据应用统计学软件SPSS 22.0处理。围手术期相关指标、肛门功能等计量资料采用()表示,组内比较行配对样本t检验,组间比较行独立样本t检验;术后并发症等计数资料采用[例(%)]表示,行χ2检验;分化程度、吻合口漏分级等等级计数资料行秩和检验。P<0.05为差异有统计学意义。结果两组患者手术时间、术中出血量及淋巴结清扫数目比较,差异无统计学意义(P>0.05);留置组患者术后排气时间、术后进食时间及术后住院时间较传统组显著缩短(P<0.05)。留置组患者术后吻合口漏的严重程度较传统组轻,且吻合口漏的总发生率(4.3%vs.23.5%)及其相关并发症的总发生率(2.2%vs.17.6%)均显著低于传统组,差异均有统计学意义(P<0.05)。术后3个月两组患者便意、感觉功能、控制能力、排便时间及排便次数评分较术前均显著升高,且留置组患者各项肛门功能评分均显著高于传统组(P<0.05)。结论nCRT后中低位直肠癌行腹腔镜TME术后留置肛管可有效减轻术后吻合口漏的严重程度,降低吻合口相关并发症的发生率,有效促进患者术后恢复,改善肛门功能,值得推广用。

Objective To investigate the clinical study of laparoscopic total mesangectomy(TME)after neoadjuvant chemoradiotherapy(nCRT)for middle and low rectal cancer with indentations anal tube.Methods Clinical data of 80 patients with medium-low rectal disease from January 2019 to December 2022 were retrospectively analyzed.All patients received nCRT before surgery and then underwent laparoscopic TME.46 patients had anal catheter indwelling after surgery as the indwelling group,and 34 patients without postoperative anal catheter were selected as the traditional group strictly according to the matching principles of gender,age,body mass index(BMI),tumor diameter,distance from the lower tumor margin to the anus,degree of differentiation,and TNM stage.Data was processed by SPSS 22.0.Perioperative indicators,anal function and other measurement data were represented by().Paired t test was performed for intra-group comparison and independent t test was performed for inter-group comparison.The statistical data of postoperative complications were represented by cases(%),χ2 test,and row Rank Sum test of differentiation degree and anastomotic leakage grade.P<0.05 was considered statistically significant.Results There was no significant difference in operation time,intraoperative blood loss and number of lymph nodes dissection between the two groups(P>0.05).Postoperative exhaust time,postoperative feeding time and postoperative hospital stay in indignant group were significantly shorter than those in traditional group,with statistical significance(P<0.05).The total incidence of anastomotic leakage(4.3%vs.23.5%)and its related complications(2.2%vs.17.6%)were significantly lower than those in the non-indwelling group,with statistical significance(P<0.05).Three months after surgery,scores of bowel intention,sensory function,control ability,defecation time and frequency of defecation in 2 groups were significantly higher than those before surgery,and scores of anal function in indenture group were significantly higher than those in traditional group,with statistical significance(P<0.05).Conclusion Anal catheterization after laparoscopic TME for middle and low rectal cancer after nCRT can effectively reduce the severity of postoperative anastomotic leakage,reduce the incidence of anastomose-related complications,effectively promote postoperative recovery of patients,and improve anal function,which is worth popularizing.