双套管肛管对腹腔镜辅助下中低位直肠癌前切除术后吻合口瘘的预防效果分析

目的探讨双套管肛管对腹腔镜辅助下中低位直肠癌前切除术后吻合口瘘的预防效果。方法100例行腹腔镜辅助下中低位直肠癌前切除术患者,根据预防术后吻合口瘘方法不同分为对照组和观察组,每组50例。对照组患者使用传统腹腔引流方法,观察组患者使用双套管引流联合肛门直肠双套管持续低压冲洗方法。比较两组吻合口瘘发生情况及并发症发生情况、二次手术情况、术后6个月吻合口狭窄情况、引流管放置时间、住院情况。结果观察组吻合口瘘发生率稍低于对照组,但差异无统计学意义(P>0.05);两组吻合口瘘发生时间均为(7.2±1.5)d,比较差异无统计学意义(P>0.05);观察组吻合口瘘相关并发症发生率10.00%、其他并发症发生率6.00%均低于对照组的26.00%、20.00%,差异具有统计学意义(P<0.05)。观察组二次手术率0、术后6个月吻合口狭窄率0均低于对照组的10.00%、8.00%,差异具有统计学意义(P<0.05)。观察组引流管放置时间(9.5±2.7)d、住院时间(15.5±4.8)d短于对照组的(15.4±4.3)、(21.3±5.7)d,住院费用(43547±3256)元少于对照组的(53439±4798)元,差异具有统计学意义(P<0.05)。结论双套管肛管对腹腔镜辅助下中低位直肠癌前切除术后吻合口瘘有一定预防效果,但不能降低吻合口瘘发生率,能缩短术后引流时间及住院时间,降低二次手术率,值得推广使用。

Analysis of prevention effect of double-tube anal canal on anastomotic fistula after laparoscopic assisted mid-low rectal precancerous resection

Objective To discuss the prevention effect of double-tube anal canal on anastomotic fistula after laparoscopic assisted mid-low rectal precancerous resection.Methods A total of 100 cases of patients with laparoscopic assisted mid-low rectal precancerous resection were divided into control group and observation group according to different methods of preventing postoperative anastomotic fistula,with 50 cases in each group.The control group received traditional abdominal drainage,and the observation group received double-tube drainage combined with anorectal double cannula continuous low pressure washing.The occurrence of anastomotic fistula,complications,secondary operation,anastomotic stenosis at 6 months after operation,drainage tube placement time and hospitalization time were compared between the two groups.Results The incidence of anastomotic fistula in the observation group was a little lower than that in the control group,but the difference was not statistically significant(P>0.05).The duration of anastomotic leakage were both(7.2±1.5)d in the two groups,and the difference was not statistically significant(P>0.05).The incidence of anastomotic fistula related complications 10.00%and other incidence of complications 6.00%in the observation group were all lower than 26.00%and 20.00%in the control group,and the difference was statistically significant(P<0.05).The secondary operation rate 0,anastomotic stenosis rate at 6 months after operation 0 in the observation group were all lower than 10.00%and 8.00%in the control group,and the difference was statistically significant(P<0.05).The drainage tube placement time(9.5±2.7)d and hospitalization time(15.5±4.8)d in the observation group were shorter than(15.4±4.3)and(21.3±5.7)d in the control group,and hospitalization costs(43547±3256)yuan was less than(53439±4798)yuan in the control group.Their difference was statistically significant(P<0.05).Conclusion Double-tube anal canal can prevent anastomotic fistula after laparoscopic assisted anterior resection of mid-low rectal cancer.It can not reduce the incidence of anastomotic fistula,but it can shorten postoperative drainage time and hospitalization time,and reduce the rate of secondary operation,which is worth popularizing and applying.