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目的探讨三管冲洗引流减压对预防行直肠癌全直肠系膜切除术(TME)术后吻合口瘘发生的意义。方法将南京军区福州总医院普外研究所3年间收治的332例TME术患者随机分为A,B两组,每组166例。A组放置自制三管行冲洗引流;B组用常规引流,两组引流管均置于直肠内吻合口上5 cm处。观察两组肛管直肠压力的变化及瘘的发生率。结果术后第4天肛管直肠压力最高。A组术后均未发生吻合口瘘,B组术后发生吻合口瘘11例(6.62%,11/166),术后第4天瘘发生的例数最多,两组间差异具有统计学意义(χ2=11.389,P=0.001)。B组吻合口瘘中9例经非手术治疗痊愈,2例行近端肠造瘘转流术治愈。两组均无无围手术期死亡。结论三管冲洗引流减压能有效地预防TME术后吻合口瘘的发生。
Objective To investigate the significance of three-tube irrigation and drainage decompression in preventing anastomotic fistula after total mesorectal excision (TME) of rectal cancer. Methods A total of 332 TME patients admitted to the General Hospital of Fuzhou General Hospital of Nanjing Military Region for three years were randomly divided into A and B groups, with 166 cases in each group. Group A placed three lines of self-made irrigation and drainage; Group B with conventional drainage, drainage tube were placed in both groups at the rectum anastomosis 5 cm Department. The changes of rectal pressure and the incidence of fistula in the two groups were observed. Results The fourth postoperative anal canal pressure was the highest. In group A, no anastomotic fistula occurred after operation. In group B, anastomotic fistula occurred in 11 cases (6.62%, 11/166), and the largest number of fistula occurred on the fourth day after operation. The difference between the two groups was statistically significant (χ2 = 11.389, P = 0.001). In group B, 9 cases of anastomotic fistula were cured by non-surgical treatment and 2 cases were treated by proximal intestinal fistula bypass. Perioperative deaths were found in both groups. Conclusion Three-tube irrigation and drainage decompression can effectively prevent the occurrence of anastomotic fistula after TME.