留置肛管与保护性造口预防直肠癌术后吻合口瘘的现状与进展

随着全直肠系膜切除术的概念普及以及手术器械的改进,保肛手术越来越多。目前吻合口瘘依然是直肠癌前切除术后最严重的并发症。吻合口瘘的发生与代谢性疾病、术前新辅助治疗、吻合口距肛缘距离、血供、张力等因素相关。大多数文献认为留置肛管对于预防吻合口瘘有积极作用,但因为纳入标准的不同,导致研究结果存在偏差。目前公认的预防吻合口瘘的方法是留置肛管和保护性造口,但是二者比较研究尚存争议。因此,期待未来开展更多的前瞻性与回顾性实验来比较研究留置肛管与保护性造口对直肠癌特别是低位直肠癌前切除术后吻合口瘘的预防作用。

Progress of transanal tube and defunctioning stoma in preventing anastomotic leakage after rectal cancer operation

With the popularization of the concept of total mesorectal excision and the improvement of surgical instruments，anus-preserving surgery is becoming more and more popular.However，anastomotic leakage (AL) is still one of the most serious complications after anterior resection of rectal cancer.The occurrence of anastomotic leakage is related to metabolic diseases，preoperative neoadjuvant therapy，distance from anastomotic site to anal margin，blood supply，tension and so on.Most literatures suggest that the transanal tube (TB) has a positive effect on the prevention of AL.Due to the inclusion of different criteria，there is a deviation in the results of the study.TB and defunctioning stoma (DS) are the common methods to prevent anastomotic leakage，but the comparison between them is still controversial.Therefore，it is expected that more prospective and retrospective experiments will be carried out in the future to compare the preventive effects of TB and DS on AL in rectal cancer，especially in patients with low rectal cancer after anterior resection.