T. Tominaga, Takashi Nonaka, A. Fukuda, Masaaki Moriyama, S. Oyama, Mitsuhisa Ishii, Y. Sumida, H. Takeshita, Makoto Hisanaga, H. Fukuoka, Kazuo Tou, Kenji Tanaka, Terumitsu Sawai, Takeshi Nagayasu
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引用次数: 0
摘要
与保留括约肌手术相关的吻合口漏(AL)发生率有所上升。据报道,分流造口(DS)和经肛置管(TT)可降低 AL 的发生率。这项多中心研究探讨了 TT 和 DS 在预防直肠癌患者 AL 方面的疗效。 我们回顾了 2016 年 4 月至 2020 年 3 月间接受低位前切除术并进行双缝合重建的 126 例患者。根据存在(90 人)或不存在(36 人)TT 将患者分为两组。比较两组患者的临床病理特征。 21名患者(16.7%)出现了AL。严重 AL 的发生率在 TT 组(7.7%)明显低于非 TT 组(19.4%,P <0.001)。两组患者的表现状态、手术时间、失血量和住院时间相似。发生 AL 的患者住院时间明显更长(29 天对 15 天,P < 0.001)。多变量分析显示,放置 TT 是预测无 AL 的独立因素(几率比 0.306;95% 置信区间 0.108-0.870;P = 0.026)。21 名患者同时接受了 DS 构建和 TT 置入术,但无一人出现严重 AL。 本项多中心研究证实了经肛管置管对预防 AL 的有效性。经肛门置管可能对部分 DS 患者的 AL 有协同作用。
Utility of Transanal Tube for Preventing Severe Anastomotic Leakage Following Low Anterior Resection for Patients With Diverting Stoma
The incidence of anastomotic leakage (AL) associated with sphincter-preserving surgery has increased. Diverting stoma (DS) and transanal tube (TT) placement have been reported to reduce the rate of AL. This multicenter study examined the efficacy of TT and DS for preventing AL in rectal cancer patients.
We reviewed 126 patients who underwent low anterior resection with double-stapling reconstruction between April 2016 and March 2020. Patients were divided into 2 groups according to presence (n = 90) or absence (n = 36) of a TT. Clinicopathologic features were compared between groups.
Twenty-one patients (16.7%) experienced AL. Frequency of severe AL was significantly lower in the TT group (7.7%) than in the non-TT group (19.4%, P < 0.001). Performance status, operation time, blood loss, and hospital stay were similar between groups. Patients who experienced AL showed significantly longer hospital stays (29 days versus 15 days, P < 0.001). Multivariate analysis revealed placement of a TT as an independent predictor of no AL (odds ratio, 0.306; 95% confidence interval, 0.108–0.870; P = 0.026). Twenty-one patients received both DS construction and TT placement; none of them experienced severe AL.
The present multicenter study confirmed the efficacy of TT for preventing AL. Transanal tube may have synergistic effects against AL in selected patients with DS.