天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (11): 1359-1362.doi: 10.11958/20160087

• 临床研究 • 上一篇    下一篇

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

闫威， 李松明， 李瑞， 张嘉越， 岑延增， 冷津立， 赖彦华， 何红艳， 羊涛△   

  1. 中国人民解放军第三〇三医院普通外科 （邮编 530021）
  • 收稿日期:2016-02-29 修回日期:2016-07-22 出版日期:2016-11-15 发布日期:2016-11-15
  • 通讯作者: 通讯作者 E-mail:154869200@qq.com E-mail:154869200@qq.com
  • 作者简介:闫威 （1981）， 男， 硕士研究生， 主治医师， 主要从事结、 直肠肛门外科临床研究

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

YAN Wei, LI Songming, LI Rui, ZHANG Jiayue, CEN Yanzeng, LENG Jinli, LAI Yanhua, HE Hongyan, YANG Tao△   

  1. Department of General Surgery, NO. 303 Hospital of PLA, Nanning 530021, China
  • Received:2016-02-29 Revised:2016-07-22 Published:2016-11-15 Online:2016-11-15
  • Contact: △Corresponding Author E-mail:154869200@qq.com E-mail:154869200@qq.com

PDF (PC)

3663

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。

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

Abstract: Objective To investigate the feasibility and safety 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. Methods A total of 650 cases with low rectal cancer treated in our hospital from January 2009 to December 2014 were retrospectively collected and divided 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 was underwent double cavity casing negative pressure drainage by inside and outside of the intestine in the primary resection and anastomosis. The operation time, bleeding volume, the period of anal exhaust after operation and hospital expenses were compared between three groups. Postoperative follow- up was performed, and anastomotic leakage, postoperative infection and other complications were analyzed. Results There were no significant differences in the operation time, bleeding volume and the period of anal exhaust after operation between three groups (P > 0.05). The hospital stay and expenses were shorter and lower in drainage group than those in stoma group (P < 0.05). In addition, there were no significant differences in wound 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 of anastomotic leakage in Dixon, while the effect needs to be confirmed by large clinical trial， at the same time, patients enjoy shorter hospital stay, fewer suffering and lower expense of hospitalization.

Key words: rectal neoplasms, anastomosis, surgical, drainage, postoperative complications, low rectal cancer, Dixon operation, double cavity casing, anastomotic leakage