Application of a new type of anastomotic decompression and drainage device in laparoscopic anal preservation surgery for rectal cancer

doi:10.3877/cma.j.issn.1674-3946.2023.02.024

Abstract

Abstract:

Objective

To investigate the clinical effect of placing a new type of anastomotic decompression and drainage device through the anus to prevent anastomotic leakage after laparoscopic radical resection of rectal cancer.

Methods

Clinical data of 77 patients who underwent laparoscopic radical resection for rectal cancer from May 2019 to December 2021 were retrospectively analyzed. The observation group included 34 patients with a new type of anastomotic decompression and drainage device placed through the anus，and the control group included 43 patients without the device. SPSS 22.0 software was used for statistical analysis of the clinical data. The measurement data of preoperative serum albumin level，postoperative exhaust time and postoperative hospital stay of the two groups were expressed as（

x ˉ

±s），and independent sample t test was used. Statistical data such as the incidence of postoperative anastomotic leakage were compared using χ² test. When P<0.05，the difference was statistically significant.

Results

The incidence of anastomotic leakage in the observation group was lower than that in the control group［2.9%（1/34）vs. 18.6%（8/43），P=0.034］，and the postoperative exhaust was earlier［（3.5±1.4）d vs.（4.4±1.9）d，P=0.012］. There was no significant difference in postoperative hospital stay between the two groups（P=0.393）.

Conclusion

After laparoscopic radical resection of rectal cancer，a new type of anastomotic decompression and drainage device can effectively reduce the incidence of anastomotic leakage.

Key words: Rectal Neoplasms, Laparoscopes, Anastomotic Leakage, Decompression Drainage Device

Kaiyu Jian, Lin Jiang, Qianru Xu, Xin Lu, Yonggui Fu, Feng Liang. Application of a new type of anastomotic decompression and drainage device in laparoscopic anal preservation surgery for rectal cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(02): 209-212.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2023.02.024

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References 27

[1]	Sung H，Ferlay J，Siegel RL，et al. Global Cancer Statistics 2020：GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries［J］. CA Cancer J Clin，2021，71（3）：209-249.
[2]	姚宏伟，李心翔，崔龙，等. 中国结直肠癌手术病例登记数据库2019年度报告：一项全国性登记研究［J］. 中国实用外科杂志，2020，40（01）：106-110，116.
[3]	Damen N，Spilsbury K，Levitt M，et al. Anastomotic leaks in colorectal surgery［J］. ANZ J Surg，2014，84（10）：763-768.
[4]	Davis B，Rivadeneira DE. Complications of colorectal anastomoses：leaks，strictures，and bleeding［J］. Surg Clin North Am，2013，93（1）：61-87.
[5]	Hammond J，Lim S，Wan Y，et al. The burden of gastrointestinal anastomotic leaks：an evaluation of clinical and economic outcomes［J］. J Gastrointest Surg，2014，18（6）：1176-1185.
[6]	梁峰，鲁鑫，张宏艳，等. 低位直肠吻合口减压引流装置［P］. 中国：ZL 2020 2 1715346.7，2021年06月01日.
[7]	Rahbari NN，Weitz J，Hohenberger W，et al. Definition and grading of anastomotic leakage following anterior resection of the rectum：a proposal by the International Study Group of Rectal Cancer［J］. Surgery，2010，147（3）：339-351.
[8]	中华医学会外科学分会结直肠外科学组. 中国直肠癌手术吻合口漏诊断、预防及处理专家共识（2019版）［J］. 中华胃肠外科杂志，2019，22（03）：201-206.
[9]	吴清，陈海军，周进. 直肠癌全系膜切除术后吻合口漏形成的危险因素分析［J/CD］. 中华普外科手术学杂志（电子版），2021，15（01）：43-45.
[10]	童院生，姜宝，郑涛，等. 2015年～2020年老年直肠癌患者术后吻合口漏的高危因素分析［J/CD］. 中华普外科手术学杂志（电子版），2022，16（01）：56-58.
[11]	Morris MS，Graham LA，Chu DI，et al. Oral Antibiotic Bowel Preparation Significantly Reduces Surgical Site Infection Rates and Readmission Rates in Elective Colorectal Surgery［J］. Ann Surg，2015，261（6）：1034-1040.
[12]	Scarborough JE，Mantyh CR，Sun Z，et al. Combined Mechanical and Oral Antibiotic Bowel Preparation Reduces Incisional Surgical Site Infection and Anastomotic Leak Rates After Elective Colorectal Resection：An Analysis of Colectomy-Targeted ACS NSQIP［J］. Ann Surg，2015，262（2）：331-337.
[13]	Shiomi A，Ito M，Maeda K，et al. Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer：a propensity score matching analysis of 1，014 consecutive patients［J］. J Am Coll Surg，2015，220（2）：186-194.
[14]	朱汉建，徐家明，高进，等. 预防性回肠造口对腹腔镜直肠癌保肛患者术后肛门功能和心理因素状况的影响［J/CD］. 中华普外科手术学杂志（电子版），2022，16（01）：27-31.
[15]	Mrak K，Uranitsch S，Pedross F，et al. Diverting ileostomy versus no diversion after low anterior resection for rectal cancer：A prospective，randomized，multicenter trial［J］. Surgery，2016，159（4）：1129-1139.
[16]	Frouws MA，Snijders HS，Malm SH，et al. Clinical Relevance of a Grading System for Anastomotic Leakage After Low Anterior Resection：Analysis From a National Cohort Database［J］. Dis Colon Rectum，2017，60（7）：706-713.
[17]	Nishigori H，Ito M，Nishizawa Y，et al. Effectiveness of a transanal tube for the prevention of anastomotic leakage after rectal cancer surgery［J］. World J Surg，2014，38（7）：1843-1851.
[18]	Lee SY，Kim CH，Kim YJ，et al. Impact of anal decompression on anastomotic leakage after low anterior resection for rectal cancer：a propensity score matching analysis［J］. Langenbecks Arch Surg，2015，400（7）：791-796.
[19]	邵冬冬，周建平，盛伟伟，等. 经肛气囊型气管插管对低位直肠癌术后吻合口漏影响的临床研究［J］. 辽宁医学杂志，2020，34（05）：1-4.
[20]	Yang CS，Choi GS，Park JS，et al. Rectal tube drainage reduces major anastomotic leakage after minimally invasive rectal cancer surgery［J］. Colorectal Dis，2016，18（12）：O445-O452.
[21]	Matsuda M，Tsuruta M，Hasegawa H，et al. Transanal drainage tube placement to prevent anastomotic leakage following colorectal cancer surgery with double stapling reconstruction［J］. Surg Today，2016，46（5）：613-620.
[22]	Goto S，Hida K，Kawada K，et al. Multicenter analysis of transanal tube placement for prevention of anastomotic leak after low anterior resection［J］. J Surg Oncol，2017，116（8）：989-995.
[23]	Nishigori H，Ito M，Nishizawa Y. A novel transanal tube designed to prevent anastomotic leakage after rectal cancer surgery：the WING DRAIN［J］. Surg Today，2017，47（4）：513-520.
[24]	Kawada K，Takahashi R，Hida K，et al. Impact of transanal drainage tube on anastomotic leakage after laparoscopic low anterior resection［J］. Int J Colorectal Dis，2018，33（3）：337-340.
[25]	Li Y，Gu F. Effectiveness of a large-calibre transanal drainage tube on the prevention of anastomotic leakage after anterior resection for rectal cancer［J］. J BUON，2020，25（2）：933-938.
[26]	Wang FG，Yan WM，Yan M，et al. Comparison of anastomotic leakage rate and reoperation rate between transanal tube placement and defunctioning stoma after anterior resection：A network meta-analysis of clinical data［J］. Eur J Surg Oncol，2019，45（8）：1301-1309.
[27]	Xiao L，Zhang WB，Jiang PC，et al. Can transanal tube placement after anterior resection for rectal carcinoma reduce anastomotic leakage rate？A single-institution prospective randomized study［J］. World J Surg，2011，35（6）：1367-1377.

组别	例	年龄 (岁)	性别 (男/女)	BMI (kg/m²)	肿瘤距肛缘距离(cm)
观察组	34	59.7±13.6	26/8	24.8±3.5	9.6±4.8
对照组	43	61.8±11.7	28/15	24.6±3.3	9.1±2.7
χ²/t值		-0.742	1.169	0.255	0.552
P值		0.461	0.280	0.799	0.582
组别	例	术前血清白蛋白 (g/L)		术前合并糖尿病	术前合并高血压
观察组	34	40.4±5.3		4	12
对照组	43	40.8±5.2		4	15
χ²/t值		-0.378		0.124	0.001
P值		0.707		0.725	0.970

组别	例	年龄 (岁)	性别 (男/女)	BMI (kg/m²)	肿瘤距肛缘距离(cm)
观察组	34	59.7±13.6	26/8	24.8±3.5	9.6±4.8
对照组	43	61.8±11.7	28/15	24.6±3.3	9.1±2.7
χ²/t值		-0.742	1.169	0.255	0.552
P值		0.461	0.280	0.799	0.582
组别	例	术前血清白蛋白 (g/L)		术前合并糖尿病	术前合并高血压
观察组	34	40.4±5.3		4	12
对照组	43	40.8±5.2		4	15
χ²/t值		-0.378		0.124	0.001
P值		0.707		0.725	0.970

组别	例	AL （%）	术后排气时间 (d)	术后住院时间 (d)
观察组	34	1（2.9）	3.5±1.4	13.2±9.0
对照组	43	8（18.6）	4.4±1.9	14.9±8.6
χ²/t值		4.513	-2.562	-0.859
P值		0.034	0.012	0.393

组别	例	AL （%）	术后排气时间 (d)	术后住院时间 (d)
观察组	34	1（2.9）	3.5±1.4	13.2±9.0
对照组	43	8（18.6）	4.4±1.9	14.9±8.6
χ²/t值		4.513	-2.562	-0.859
P值		0.034	0.012	0.393

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