自制气囊双套管粪便导流装置预防直肠癌前切除术后吻合口瘘  

Usefulness of self-made gasbag double-cannula stool drainage device for prevention of anastomotic leakage following anterior resection

作　　者：张冬辉[1] 何葵[1] 邱怀玉 庄哲宏[1] 刘付英聪[1] 张剑宝[1] 曾新晨[1] 

机构地区：[1]中山大学附属第八医院胃肠外科,深圳518033

出　　处：《中华胃肠外科杂志》2017年第8期914-918,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：深圳市科创委2016年科研立项（JCYJ20160428181505577）;深圳市福田区卫生公益性科研项目（FTWS2016007）

摘　　要：目的 探讨应用自制气囊双套管粪便导流装置预防直肠癌前切除术后吻合口瘘的临床价值。 方法 回顾性分析2010年10月至2016年10月期间，在中山大学附属第八医院接受直肠前切除手术的169例直肠癌患者的临床资料，根据术中是否放置自制气囊双套管粪便导流装置分为粪便导流组（71例）和未导流组（98例）。粪便导流装置放置方法：吻合完成后，由助手置入粪便导流装置，主管远端超过吻合口15 cm以上，给气囊充气，以肠腔充分扩张；7号丝线缝合肛周皮肤，捆绑、固定主管，主管超过肛门外保留3~5 cm，接引流袋。比较两组患者的术后吻合口瘘发生情况。 结果 两组基线资料的比较，差异无统计学意义（均P 〉 0.05）。两组患者手术时间、术中出血量和术后肠功能恢复时间相当（均P 〉 0.05），但粪便导流组患者术后进食时间和术后住院时间明显缩短（P= 0.041和P= 0.013）。两组均无围手术期死亡病例，粪便导流组术后有6例（8.5%）患者因不能耐受而于48 h内拔除导流装置；术后因气囊破裂更换气囊5例次；粪便堵塞导管21例次，冲洗不复通后拔除3例。粪便导流组术后吻合口瘘发生率明显低于未导流组[2.8%（2/71）比11.2%（11/98），P= 0.043]，尤其是对于低位吻合者（吻合口距肛缘〈5 cm）[2.3%（1/43）比15.4%（10/65），P= 0.028]，而对于高位吻合者，两组吻合口瘘发生率的差异无统计学意义[3.6%（1/28）比3.0%（1/33），P= 0.906]。Logistic回归分析显示，放置粪便导流装置是直肠癌患者术后吻合口瘘发生的独立保护因素（OR= 0.316，95%CI：0.114~0.769；P= 0.003）。 结论 自制气囊双套管粪便导流装置能有效预防直肠前切除术后吻合口瘘的发生，但对于高位吻合者不推荐使用。Objective To evaluate the efficacy of self-made gasbag double-cannula stool drainage device for prevention of anastomotic leakage following anterior resection. Methods Clinical data of 169 rectal cancer patients in the 8th Affiliated Hospital of Sun Yat-sen University between October 2010 and October 2016 were retrospectively analyzed. Among them, a self-made gasbag double-cannula stool drainage device was placed in 71 patients （stool drainage group） , and the remaining 98 patients were taken as control. After an anastomosis, the drainage device was transanally placed by the assistant and the distal tube of drainage device was stretched more than 15 cm from anastomosis. The gasbag was inflated to fully expand the intestine. The main tube was fixed on perianal skin with 7-0 suture, kept more than 3-5 cm outside the anus, and connected to the drainage bag. The incidence of anastomotic leakage was compared between the two groups. Results The baseline data were similar between the two groups （all P 〉 0.05） . The differences in operative time, intraoperative blood loss, and time to bowel function recovery were not statistically significant （all P 〉 0.05） , however, time to oral intake and postoperative stay were shorter in stool drainage group as compared to the control group （both P 〈 0.05） . There was no perioperative death in both groups. In stool drainage group, there were 6 cases whose drainage device was pulled out within 48 hours due to intolerance. The ruptured gasbag was replaced 5 times and the tube was clogged by fecal material 21 times. After flushing, the tube did not recanalized and was pulled out in 3 cases. The incidence of anastomotic leakage in stool drainage group was significantly lower than that in the control group （2.8% vs. 11.2%, P= 0.043） . As for the low anastomosis （the distance to anal verge less than 5 cm） , the incidence of anastomotic leakage in stool drainage group was also significantly lower than that in the control group （2.3% vs. 15.4%, P=0.028） ,

关 键 词：直肠肿瘤 直肠前切除术 吻合口瘘 预防 

分 类 号：R735.37[医药卫生—肿瘤]