经腹膜外双套管持续负压冲洗法对直肠癌低位前切除术后吻合口瘘的防治研究

目的：对比经腹膜外放置自制简易双套管并持续负压冲洗法与传统腹腔引流方法防治直肠癌低位前切除术后吻合口瘘的临床疗效。方法回顾性分析2007年1月至2012年3月南京军区福州总医院普通外科同一手术组实施的627例数据完整的开腹直肠癌低位前切除术患者的临床资料，其中370例采用自制简易双套管在术中放置于吻合口背侧，经左侧腹膜外穿出，并固定于腹壁皮肤进行引流（双套管组），257例经腹腔放置常规引流管（常规引流组）。对比两组患者吻合口瘘发生率以及手术干预率、引流管放置时间、住院时间、住院费用、生活质量评分和半年随访时吻合口狭窄的发生率。结果全组患者术后吻合口瘘发生率为4．0％（25／627），其中双套管组14例（3．8％，14／370），常规引流组11例（4．3％，11／257），差异无统计学意义（P＞0．05）。双套管组患者吻合口瘘发生后，经肛门在直肠内放置另一自制简易双套管进行持续低负压（50 mmHg）冲洗后治愈，无需再次手术干预。而常规引流组联合经直肠放置双套管冲洗，保守治疗半月无效后有5例进行了再次手术。双套管组和常规引流组引流管放置时间分别为（9．7±2．7） d和（16．4±3．6） d；住院时间分别为（15．7±4．3） d和（21．5±6．4） d；住院费用分别为（42470±3190）元和（53480±5630）元；两组比较，差异均有统计学意义（均P＜0．05）。生活质量调查结果显示，术后15 d双套管组总体生活质量明显优于常规引流组（P＜0．05）。结论尽管经腹膜外放置自制简易双套管并不能降低直肠癌低位前切除术后吻合口瘘发生率，但该方法联合经肛门在直肠内放置另一双套管持续负压冲洗可以提高吻合口瘘保守治疗成功率，降低吻合口瘘手术干预的比率，提高患者生活质量。

Continuous negative pressure-flush through extraperitoneal dual tube in the treatment and ;prevention for rectal cancer patients with anastomotic leakage after low anterior resection

Objective To compare the efficacy between continuous negative pressure-flush through extraperitoneal dual tube and conventional drainage in the treatment and prevention for anastomotic leakage after low anterior resection in patients with rectal cancer. Methods Clinical data of 627 rectal cancer patients undergoing low anterior resection by the same surgical team from January 2007 to March 2012 were reviewed retrospectively. Of 627 patients, 370 received self-made easy extraperitoneal dual tube which was placed in the dorsal site of an anastomosis for drainage （dual tube group）, and the other 257 received conventional drainage tube from abdominal cavity （convention group） prophylactically. The incidence of postoperative anastomotic leakage, reoperation rate, drainage tube indwelling duration, hospitalization duration, hospitalization expense, quality of life score, incidence of anastomotic stricture within 6 months after operation were compared between the two groups. Results Anastomotic leakage after low Dixon operation was found in 25 cases （4.0%, 25/627）, including 14 cases （3.8%, 14/370） in dual tube group, and 11 cases （4.3%,11/257） in convention＆amp;nbsp;group, and the difference was not statistically significant. After anastomotic leakage occurrence, all the patients in dual tube group were managed by continuous negative pressure （50 mmHg）-flush through another self-made easy intra-rectal dual tube without reoperation , while 5 patients in conventional group underwent operation again because of treatment failure with continuous negative pressure-flush through intra-rectal dual tube for half a month. Drainage tube indwelling duration was （9.7 ±2.7） d and （16.4±3.6） d, hospitalization duration was （15.7±4.3） d and（21.5±6.4） d, hospitalization expenses was （42 470±3190） Yuan and （53 480±5630） Yuan in dual tube group and conventional group respectively , the differences were all statistically significant （all P〈0.05）. Quality of life on the 15th day of anasmototic leakage treatment was significantly better in dual tube group as compared to conventional group （P〈0.05）. Conclusion Though continuous negative pressure-flush through extraperitoneal dual tube can not decrease the incidence of anastomotic leakage in rectal cancer patients after low anterior resection, it may increase the successful rate of conservative therapy, decrease the reoperation rate, and improve the quality of life when combined with the use of an intra-rectal dual tube.