经肛漏口置管引流对结直肠吻合口漏病人肛门功能和生活质量的疗效评估

Efficacy of transanal drainage for anal function and quality-of-life in patients of colorectal anastomotic leakage

目的探讨经肛门吻合口漏口置管引流治疗结直肠吻合口漏病人的临床疗效及对肛门功能和生活质量的影响。方法回顾性分析2007年1月1日至2023年12月31日间1016例中国人民解放军中部战区总医院普通外科行结直肠吻合病人的临床资料,术后218例病人发生吻合口漏,15例病人因严重腹腔感染和弥漫性腹膜炎再次手术行结肠造瘘术,115例病人吻合口漏经保守治疗后好转,10例病人因资料缺失无法随访,最终回顾性分析78例吻合口漏病人临床资料,其中采用经肛门吻合口漏口置管引流18例(研究组)、单纯经腹置管引流60例(对照组)。通过低位直肠前切除综合征(low anterior resection syndrome,LARS)评价量表、Wexner大便失禁评分量表(Wexner评分)和欧洲癌症研究与治疗组织(EORTC)生命质量测定量表(EORTC QLQ-C30)来评估病人术后生活质量和肛门功能。结果78例结直肠术后吻合口漏病人经治疗后均治愈出院,两组病人未发生明显弥漫性腹膜炎和腹腔感染。两组病人均在出院后3个月进行复查随访,肿瘤无复发情况,无吻合口狭窄及瘢痕增生。肛门功能评价方面:研究组与对照组比较,病人在置管前的LARS评分[(20.28±9.95)分比(25.55±11.71)分]和Wexner评分[(10.56±2.36)分比(13.00±2.52)分]均较低,差异均有统计学意义(均P<0.05)。但置管后两组评分差异均无统计学意义(均P>0.05)。EORTC QLQ-C30生活质量评价方面:研究组病人置管前在角色功能领域、社会功能领域和气促症状方面较对照组表现更差,差异均有统计学意义(均P<0.05);但置管后两组病人生活质量评分差异均无统计学意义(均P>0.05)。结论经肛门吻合口漏口置管冲洗引流可作为结直肠术后病人吻合口漏重要的治疗措施,随着术后恢复,病人肛门功能未造成损伤,提高了病人生活质量,降低吻合口狭窄率,减少了二次手术造口的风险,并保障治疗的安全性,值得临床推广应用。

Objective To explore the clinical efficacy of transanal anastomotic drainage for colorectal anastomotic leakage and examine its impact on anal function and quality-of-life.Methods From January 1,2007 to December 31,2023,the relevant clinical data were retrospectively reviewed for 1016 patients undergoing colorectal anastomosis.Postoperative anastomotic leakage occurred in 218 patients and colostomy was repeated in 15 patients due to severe abdominal infection and diffuse peritonitis.And 115 patients of anastomotic leakage improved after conservative measures and 10 cases could not be followed up due to missing data.Finally the relevant clinical data were retrospectively reviewed for 78 patients of anastomotic leakage.They were assigned into two groups of transanal drainage(study,n=18)and simple transabdominal drainage(control,n=60).They were examined by assessment scales of low anterior resection syndrome(LARS)and Wexner fecal incontinence and European Organization for Research and Treatment of Cancer(EORTC).And EORTC Quality-of-Life Scale(EORTC QLQ-C30)was employed for assessing postoperative quality-of-life and anal function.Results After colorectal operation,78 patients of anastomotic leakage were cured and discharged from hospital.No obvious diffuse peritonitis or abdominal infection occurred.Both groups were followed up for 3 months post-discharge.There was no recurrence of tumor,anastomotic stenosis or scar hyperplasia.Anal function:As compared with control group,the scores of LARS[(20.28±9.95)vs.(25.55±11.71)points]and Wexner[(10.56±2.36)vs.(13.00±2.52)points]were lower in study group pre-catheterization and the differences were statistically significant(all P<0.05).However,there was no significant inter-group difference post-catheterization(all P>0.05).EORTC QLQ-C30 quality-of-life:Prior to catheterization,study group demonstrated worse performance in the domains of role function,social function and respiratory symptoms than those in control group.And the differences were statistically significant(all P<0.05).However,no significant inter-group difference existed in EORTC QLQ-C30 score post-catheterization(all P>0.05).Conclusion Catheter irrigation and drainage through anal anastomotic leakage may be an important treatment for patients of anastomotic leakage after colorectal surgery.As anal function is restored after surgery,quality-of-life improves,rate of anastomotic stenosis drops and the chance of a second stomy is minimized.This safe treatment is worthy of wider clinical applications.