改良骶前间隙引流途径在腹腔镜超低位直肠癌根治保肛术后吻合口瘘中的应用*

Application of modified drainage in laparoscopic anastomotic leakage after ultra-low rectal cancer*

摘要:

目的 探讨经改良骶前间隙引流途径冲洗腹腔镜超低位直肠癌根治保肛术后吻合口瘘（AL）的临床应用疗效。方法 回顾性分析2008年1月—2018年8月西南医科大学附属医院收治的33例行腹腔镜超低位直肠癌根治保肛术后吻合口瘘患者的临床资料，根据引流管拔出途径将吻合口瘘患者分为17例传统途径组（传统组）和16例改良途径组（改良组）。传统途径组引流管由骶前间隙路径腹腔拔出，改良途径组引流管经坐骨结节与尾骨连线中点外侧、距肛缘约2.0?cm处拖出。对比分析两组疗效、并发症发生情况。结果 改良组腹膜炎和腹腔积液发生率低于传统组（P?<0.05），患者平均住院时间和引流管拔出时间亦均短于传统组（P?<0.05）。结论 经改良骶前间隙引流途径冲洗超低位直肠癌吻合口瘘应用安全，减少AL伴发的并发症，缩短住院和冲洗引流时间，此改良途径更适合腹腔镜超低位直肠癌根治保肛术，值得在临床中推广与使用。

Abstract:

Objective To investigate clinical application of improved presacral space drainage pathways in anastomotic leakage after laparoscopic resection of super-lower rectal cancer with sphincter preservation. Methods In this retrospective study, we enrolled 33 cases undergoing laparoscopic resection of super-lower rectal cancer with sphincter preservation in the Affiliated Hospital of Southwest Medical University from January 2008 to August 2018. According to the way the drainage tube was pulled through the presacral space, patients were divided into traditional pathway group (n?=?17) and improved pathway group (n?=?16). The effect and the incidence of complications were compared between the groups. Results The incidence of peritonitis and seroperitoneum in the improved group were decreased than those in traditional group (P??0.05). Conclusions Using improved presacral space drainage pathways in condition of anastomotic leakage is safe and suitable for patients undergoing laparoscopic resection of super-lower rectal cancer, which can reduce the complications of anastomotic leakage and shorten the hospitalization time.