肠腔内、外双套管负压引流在低位直肠癌一期切除吻合术中的应用  

Application of the double cavity casing negative pressure drainage by inside and outside of the intestine in the primary resection and anastomosis of low rectal cancer

作　　者：闫威[1] 李松明[1] 李瑞[1] 张嘉越[1] 岑延增[1] 冷津立[1] 赖彦华[1] 何红艳[1] 羊涛[1] 

机构地区：[1]中国人民解放军第三〇三医院普通外科,530021

出　　处：《天津医药》2016年第11期1359-1362,共4页Tianjin Medical Journal

摘　　要：目的探讨肠腔内、外双套管负压引流在低位直肠癌一期切除吻合中的可行性与安全性。方法回顾性收集2009年1月—2014年12月期间收治的650例低位直肠癌患者资料,分为对照组(n=220)、造口组(n=205)和引流组(n=225)。对照组采用Dixon术(直肠低位前切除术);造口组行Dixon术加预防性末端回肠造口术,二期手术还纳;引流组行Dixon术,术中放置肠腔内、外双套管持续灌洗负压引流。比较3组患者手术时间、术中出血量、术后排气时间、住院费用的差异。术后进行随访,分析3组术后吻合口漏及术后感染等并发症发生情况。结果 3组手术时间、术中出血量以及术后排气时间差异无统计学意义(P>0.05);引流组患者住院时间和住院费用低于造口组(P<0.05)。在并发症方面,3组患者的吻合口漏发生率、切口感染、盆、腹腔感染、肺部感染的发生率差异无统计学意义(P>0.05)。术后随访结果显示,3组患者的复发、转移及死亡比例差异均无统计学意义(P>0.05)。结论肠腔内、外双套管负压引流可缩短低位直肠癌患者Dixon术后的住院时间,减轻患者负担,能否降低术后吻合口漏发生率需进一步证实。Objective To investigate the feasibility and safety of the double cavity casing negative pressure drainageby inside and outside of the intestine in the primary resection and anastomosis of low rectal cancer. Methods A total of 650 cases with low rectal cancer treated in our hospital from January 2009 to December 2014 were retrospectively collected anddivided into control group(n=220), stoma group(n=205) and drainage group(n=225). The control group was received Dixon(low rectal anterior resection), the stoma group was treated with Dixon and ileostomy, while the drainage group wasunderwent double cavity casing negative pressure drainage by inside and outside of the intestine in the primary resection andanastomosis. The operation time, bleeding volume, the period of anal exhaust after operation and hospital expenses werecompared between three groups. Postoperative follow-up was performed, and anastomotic leakage, postoperative infectionand other complications were analyzed. Results There were no significant differences in the operation time, bleedingvolume and the period of anal exhaust after operation between three groups(P > 0.05). The hospital stay and expenses wereshorter and lower in drainage group than those in stoma group(P < 0.05). In addition, there were no significant differences inwound infection, pelvic infection, and pulmonary infection between three groups(P > 0.05). All patients were followed up,and the mortality, the recurrence rate and metastasis rate were not significantly different between three groups(P > 0.05).Conclusion The application of double cavity casing negative pressure drainage is likely to reduce the incidence ofanastomotic leakage in Dixon, while the effect needs to be confirmed by large clinical trial,at the same time, patients enjoyshorter hospital stay, fewer suffering and lower expense of hospitalization.

关 键 词：直肠肿瘤 吻合术 外科 引流术 手术后并发症 低位直肠癌 DIXON术 双套管引流 吻合口漏 

分 类 号：R657.1[医药卫生—外科学]