中国实用外科杂志

中国实用外科杂志

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套囊直肠引流管用于低位直肠癌全直肠系膜切除临床研究

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  1. 1厦门大学附属第一医院厦门肿瘤医院胃肠外科，福建厦门 361003；2福建医科大学第一临床医学院，福建福州 350004；3福建中医药大学第一临床医学院，福建福州 350122
  • 出版日期:2017-10-01 发布日期:2017-10-11

  • Online:2017-10-01 Published:2017-10-11

摘要：

目的    探讨套囊直肠引流管预防全直肠系膜切除（TME）术后发生吻合口漏及其促进病人康复的效果。方法    回顾性分析2015年6月至2016 年12 月厦门大学附属第一医院厦门肿瘤医院收治的行TME手术治疗的84例低位直肠癌病人的临床资料，均行保肛手术，且未做保护性肠造口。根据术中经肛门放置肛肠腔内引流管的材料分为套囊组（经肛门放置套囊直肠引流管，48例）和常规组（经肛门放置目前临床常用的普通肛管，36例）。比较两组病人术后恢复及引流管相关并发症情况。结果    与常规组相比，套囊组病人吻合口漏发生率降低［2.1%（1/48）vs. 16.7%（6/36），χ2=3.977，P=0.046］，术后下床活动时间［（2.3±0.4）d vs.（3.0±0.2）d，t=4.143，P=0.001］、肛门排气时间［（3.3±0.3）d vs. （3.9±0.5）d，t=3.536，P=0.002］、术后住院时间［（10.3±1.6）d vs. （11.8±1.1）d，t=2.384，P=0.028］均缩短，术后便频发生率［8.3%（4/48）vs. 27.8%（10/36），χ2=4.288，P=0.038］、经常便不净感发生率［12.5%（6/48） vs. 30.6%（11/36），χ2=4.155，P=0.042］、引流管相关并发症发生率［4.2%（2/48） vs. 22.2%（8/36），χ2=4.789，P=0.029］均降低。结论    全直肠系膜切除后使用套囊直肠引流管有利于降低吻合口漏的发生率，促进肛门和肠道功能的恢复，且病人耐受性好，缩短了住院时间。

关键词: 低位直肠癌, 保肛手术, 引流管, 全直肠系膜切除, 吻合口漏

Abstract:

Application of the cuff rectum drainage tube in total mesorectal excision for low rectal adenocarcinoma        LIU Gang*，WEI Bin，ZENG Jun-jie，et al. *Department of Gastrointestinal Surgery，the First Affiliated Hospital of Xiamen University ＆ Xiamen Cancer Center，Xiamen 361003，China
Corresponding author：HUANG Zheng-jie，E-mail: huangzhengjie@xmu.edu.cn
Abstract    Objective    To investigate therapeutic effect of cuff rectum drainage tube in preventing total mesorectal excision （TME）postoperative complications and promoting the recovery of the patients. Methods    The clinical data of 84 cases of low rectal cancer performed TME from June 2015 to December 2016 in the First Affiliated Hospital of Xiamen University were analyzed retrospectively. All the cases were performed anus-retained operation without preventive colostomy. Patients were divided into 2 groups according to the material of the anorectal drainage tube placed in the colonic cavity. Group I was transanal rectal cuff placement of drainage tube (Patent No. ZL 201320384337.8) (n=48) and group II was transanal placement of commonly used clinical common anus tube (n=36). Anastomotic fistula incidence, the time of anal exsufflation, postoperative first ambulation time, intestinal function recovery time, tube complication incidence and postoperative hospital stay between two groups were analyzed retrospectively. Results    Both postoperative first ambulation and anal exsufflation time in the cuff rectum drainage tube group were shorter than those in the clinical general anal tube group ［(2.3±0.4) d vs. (3.0±0.2)d，P<0.05; (3.3±0.3) d vs. (3.9±0.5)d，P<0.05］. Meanwhile, the cuff rectum drainage tube group had significance decreased postoperative hospital stay than that in the clinical general anal tube group ［(10.3±1.6) d vs. (11.8±1.1) d，P<0.05］. Significant different occurrence of complications existed in anastomotic fistula, constipation, defecating unfinished feeling, drainage tube complication between the cuff rectum drainage tube group and the clinical general anal tube group, which included constipation ［8.3%（4/48）vs. 27.8%（10/36），P<0.05］, defecating unfinished feeling ［12.5%（6/48）vs. 30.6%（11/36），P<0.05］, drainage tube complication ［4.2%（2/48）vs. 22.2%（8/36），P<0.05］. Conclusion    The cuff rectum drainage tube may reduce anastomotic fistula incidence in TME, decrease postoperative hospital stay, enable faster recovery with good toleration and shorten hospital stay.

Key words: low rectal adenocarcinoma, anus preservation surgery, drainage tube, total mesorectum excision, anatomotic fistula