摘要
目的探究直肠癌保肛手术留置肛管引流管的作用并比较乳胶型和螺纹型两种肛管引流管的优劣。方法回顾性分析安徽医科大学附属省立医院2011年1月2016年6月行直肠癌保肛手术的840位患者的临床资料,根据术后是否留置肛管引流管及肛管引流管类型,将其随机分为试验组(536例)及对照组(304例),试验组又分为两个亚组,即乳胶型肛管组(261例)和螺纹型肛管组(275例),对照组不放置引流管,就预防吻合口瘘、促进患者排气排液排便2个方面,比较试验组与对照组以及两个亚试验组间在直肠癌保肛手术中的作用。结果试验组与对照组及亚试验组患者之间在年龄、性别、糖尿病、高血压等基础疾病、BMI、术前白蛋白水平、肿瘤分期、吻合口距肛门位置等方面差异无明显统计学意义(P>0.05),试验组术后吻合口瘘发生36例(6.7%)远低于对照组33例(10.9%),试验亚组之间,螺纹管组吻合口瘘发生12例(4.4%)远低于乳胶管组24例(9.2%),差异有统计学意义(P<0.05),试验组术后首次排液、排气、排便平均时间分别为5.49±4.61 h、67.89±11.77 h,88.47 h对照组术后术后首次排液、排气、排便平均时间分别39.18±8.35 h、88.90±7.52 h、112.52±10.08 h,经T检验发现两组差异有统计学意义(P<0.05)。乳胶管组术后首次排液、排气、排便平均时间分别为5.34±2.71 h、69.23±11.92 h、90.46±9.86 h,螺纹管组术后首次排气排便平均时间为5.72±5.68 h、66.76±11.62 h、87.58±10.21 h,两组间无明显差异。结论直肠癌保肛手术留置肛管可有效预防术后吻合口瘘,促进患者排液排气排便,减少患者术后腹胀率,螺纹型肛管较乳胶型肛管在预防术后吻合口瘘上效果更好,在促进术后首次排气排液排液两组效果无明显差异。
Objective To explore effect of anal canal drainage in rectal cancer preserving surgery and compare advantages and disadvantages of latex and thread type anal canal drainage. Methods Review and analyze clinical data of 840 cases rectal cancer anus preserving surgical patients in Anhui Medical University Affiliated Provincial Hospital from January 2011 to June 2016, according to postoperative indwelling drainage and anal canal drainage tube, divide them into experimental group（536 cases） and control group（304 cases） randomly. Experimental group was divide into two sub groups, namely latex anal group（261 cases） and threaded anal group（275 cases）, control group with no drainage. On aspects of preventing anastomotic fistula, promoting liquid, exhaust and defecation, compare their effect in rectal cancer anus preserving surgery of experimental group and control group and two sub experimental groups. Results Difference of age, gender, diabetes, hypertension and other basid diseases, BMI, preoperative albumin level, tumor staging, anastomosis position from anal between experimental group and control group and sub experimental group showed no statistical significance,（P〈0.05）, 36 cases had postoperative anastomotic fistula in experimental group（6.7%）, far lower than 33 cases（10.9%） of control group, 12 cases had anastomotic fistula in sub experimental groups（4.4%）, far lower than 24 cases（9.2%） of latex tube group, difference showed statistical significance,（P〈0.05）, postoperative first discharge, exhaust, defecation time in average of experimental group was 5.49±4.61 h, 67.89±11.77 h, 88.47 h respectively, that of control group was 39.18±8.35 h, 8.90±7.52 h, 112.52±10.08 h, T test showed significant difference between two groups（P〈0.05）. Postoperative first discharge, exhaust, defecation time in average of latex tube group 5.34±2.71 h, 69.23±11.92 h, 90.46±9.86 h respectively, that of threaded tube group was 5.72±5.68 h, 66.76±11.62 h, 87.58±10.21 h, with no significant difference between two groups. Conclusion Indwelling canal of rectal cancer preserving surgery can prevent postoperative anastomotic fistula effectively, promote patient＇s discharge, exhaust and defecation, reduce postoperative abdominal distension rate, and threaded type has better effect in preventing postoperative anastomotic fistula than latex anal, and effect of promoting postoperative first discharge exhaust and and defecation showed no significant difference between two groups.
作者
朱海
何新阳
陈志强
金荣
ZHU Hai,HE Xin-yang,CHEN Zhi-qiang,JIN Rong(Department of General Surgery, Anhui Medical University Affiliated Provincial Hospital, Hefei, Anhui, 23000)
出处
《智慧健康》
2018年第6期148-152,共5页
Smart Healthcare
关键词
直肠肿瘤
吻合口瘘
肛管引流
Rectal tumor
Anastomotic fistula
Anal canal drainage
