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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 double-cannula negative intestine drainage in the primary resection and anastomosis of low rectal cancer. Methods The data of 650 patients with low rectal cancer admitted from January 2009 to December 2014 were retrospectively collected and divided into control group (n = 220), ostomy group (n = 205) and drainage group (n = 225) . The control group was treated with Dixon technique (low anterior resection of the rectum), Dixon technique with prophylactic distal ileostomy in the ostomy group, and the second stage operation. The Dixon technique was used in the drainage group, Continuous lavage tube negative pressure drainage. The operation time, intraoperative blood loss, postoperative exhaust time and hospitalization cost were compared between the three groups. Postoperative follow-up, analysis of 3 groups of postoperative anastomotic leakage and postoperative complications such as infection. Results There was no significant difference in operative time, intraoperative blood loss and postoperative exhaust time between the three groups (P> 0.05). The hospitalization and hospitalization costs of the drainage group were lower than those of the stoma group (P <0.05). There was no significant difference in the incidence of anastomotic leakage, incision infection, pelvic infection, abdominal infection and pulmonary infection among the three groups in terms of complications (P> 0.05). Postoperative follow-up results showed that there was no significant difference in the recurrence, metastasis and death among the three groups (P> 0.05). Conclusion The negative pressure drainage of intestine and external double cannula can shorten the hospitalization time after Dixon operation in patients with low rectal cancer, reduce the burden on patients and reduce the incidence of postoperative anastomotic leakage needs further confirmation.