新型肠内引流预防低位直肠吻合口瘘的临床研究

目的评价一种新型肠内引流技术预防低位直肠吻合口瘘的临床应用价值。方法将119例获得经腹切除、低位直肠吻合的直肠癌病例随机分成2组，研究组（55例）术中附加由生物可降解吻合环、避孕套复合而成的新型肠内引流装置；对照组（64例）术中附加回肠末端保护性造瘘：比较两组治疗结果。结果两组患者性别、年龄、体形、肿瘤位置、肿瘤大小、肿瘤分化、吻合位置、营养状态及伴随疾病等生理病理因素差异无统计学意义（P〉0．05）。无围手术期死亡者。全组病例3个月随访率100％。研究组吻合口瘘的发生率7．3％（4／55），内引流装置排出时间平均18．3d，无引流相关并发症，术后3个月仅见5．5％（3／55）无需松解治疗的吻合口轻度狭窄；吻合口瘘者漏后引流时间平均4．8d，前3日引流量平均12．8ml／d，无严重感染及保肛失败病例。对照组吻合口瘘发生率10．9％（7／64）；45．3％（29／64）的病例伴有肠造瘘相关并发症，3个月后有28．1％（18／64）的病例吻合口轻度狭窄，6．3％（4／64）的病例吻合口严重狭窄需进行松解治疗：吻合口瘘者漏后引流时间平均17．1d，前3日引流量平均35．4ml／d；2例并发严重感染，1例吻合口毁损而致保肛失败。两组吻合口瘘发生率的差异无统计学意义（P〉0．05），但漏后腹腔引流量、引流时间、感染及3个月后吻合口狭窄发生情况两组差异有统计学意义（P〈0．01）。结论新型肠内引流技术简便、安全．能有效避免低位直肠吻合口瘘所导致的严重后果。与预防性肠造瘘相比．保护吻合口的作用更为优越，同时也显著减少了因废用而导致的吻合口狭窄的发生率。

Clinical study of a new intracolonic drainage to protect low rectal anastomotic leakage

Objective To investigate the value of using protective new intracolonic drainage in decreasing low colorectal anastomotic leakage.Methods One hundred and nineteen cases of rectal cancer accepted low anterior resection were randomly assigned to study group(n=55)and control group (n=64).The study group was added with a new intracolonic drainage composed of biofragmentable anastomosis ring and condom during operation.The control group was added with protective ileostomy during operation.The results of surgery were compared between the two groups.Results All the cases were followed up over three months and there were no perioperative death.There were no significant differences in physiopathologieal factors such as age, sex, body type, site of tumor, size of tumor,differentiation of tumor,site of anastomosis,condition of nutrition,concomitant disease between the two groups.In the study group,anastomotic leakage occurred in 4 cases(7.3%),the drainage devices were ablated 18.3 days after operations and there were no drainage-related complications;light anastomotic stenosis occurred in 3 cases(5.5%)three months after operations.Among the cases with leakage,no severe abdominal infection was found.the time of abdominal drainage was 4.8 days.and the amount of abdominal drainage was 1 2.8 ml/d in primary three days after leakage.In the control group,anastomotic leakage occurred in 7 cases(10.9%),stomy-related complications occurred in 29 cases(45.3%),anastomotic stenosis occurred in 18 cases(28.1%)and severe anastomotic stenosis occurred in 4 cases (6.3%)after three months.Among the cases with leakage, severe infection occurred in two cases,anastomotic spoiled occurred in one case,the amount of abdominal drainage was 35.4 ml/d in primary three days after leakage,and the time of abdominal drainage was 17.1 days.There was no significant difference in the rate of anastomotic leakage between the two groups(P＞0.05).But there were significant differences in the amount of abdominal drainage,the time of abdominal drainage and abdominal infection in the cases of anastomotic leakage(P＜0.01).There was significant difference in anastomotic stenosis after three months between the two groups(P＜0.01).Conclusions The intracolonic drainage is a simple,safe and effective method in protecting low colorectal anastomotic leakage,and avoiding harmful results caused by anastomotic leakage.Compared with protective ileostomy,intracolonic drainage can avoid stomy-related physical mental suffering and complications,the rate of later anastomotic stenosis is less,and the time of abdominal drainage is shorter in the cases with leakage.