| Objiective: To investigate the safety,short-term clinical effect and effect of perineal anterior sacral drainage on postoperative anastomotic fistula in laparoscopic assisted radical resection of rectal cancer.Methods: A retrospective analysis was performed on the clinical data of 102 patients diagnosed with rectal cancer who underwent laparoscopic radical resection of rectal cancer(Dixon operation)in the Department of Gastrointestinal Surgery,the First Affiliated Hospital of Wannan Medical College from January 2020 to January 2022.Among them,52 patients underwent conventional abdominal anterior sacral drainage after surgery and were set as the control group.Fifty patients were treated with perineal anterior sacral drainage as the experimental group,and the differences between the two groups in preoperative,intraoperative and postoperative drainage volume,inflammatory indicators and other observed indicators were compared.Results: 1.A total of 102 patients with rectal cancer who underwent laparoscopic assisted radical resection of rectal cancer(Dixon operation)were included,including 50 patients in the perineal drainage tube group and 52 patients in the abdominal drainage tube group.There were no statistical differences between the two groups in gender,age,clinicopathological stage,ASA grading(American society of anesthesiologists)and other clinical base data(P > 0.05).In terms of postoperative prevention of anastomotic fistula,the perineal drainage tube group(3 cases(6%))was superior to the perineal drainage tube group(6 cases(11.5%)).There were 3 cases of anastomotic fistula in the perineal drainage tube group,all of which were washed through the drainage tube and cured by conservative treatment,and 1 case of incision infection(2%).There were 6 cases of anastomotic fistula in the group of transabdominal drainage tube,among which 4 cases were cured by continuous irrigation of drainage tube,2 patients presented local peritonitis symptoms,which were treated by secondary operation.In the group of transabdominal drainage,there was also 1 case of anastomotic hemorrhage(1.9%),2 cases of incision infection(3.8%),and 1 case of pulmonary infection(1.9%).One case was intestinal obstruction(1.9%).2.There were no significant differences in preoperative white blood cells,preoperative albumin,operative time,and intraoperative blood loss between the two groups,and there were no significant differences in visual simulation score of pain 24 h after surgery,length of staying after surgery,albumin and postoperative hemoglobin 1 week after surgery.Better drainage effect was observed in the perineal anterior sacral drainage tube group at three time points on the 1st,3rd and 5th postoperative days,with statistical significance(P < 0.05).The maximum difference in drainage volume was found on the 3rd day after surgery.The drainage volume of the perineal drainage tube group was 59.0±90.5ml,and that of the abdominal drainage tube group was 26.0±51.1ml.The drainage volume of the1 st and 5th day after surgery was also significantly different.The drainage volume of the perineal drainage tube group was 171.0±115.4ml and 52.2±98.0ml on the 1st and 5th day after surgery,and the drainage volume of the perineal drainage tube group was130.0±84.5ml and 22.3±39.9ml on the 1st and 5th day after surgery,respectively.There was no significant difference in the length of postoperative hospitalization,but when patients developed anastomotic fistula,the average postoperative hospitalization duration was 22 days in the perineal drainage group,and 23.7 days and 40 days in the abdominal drainage group after anastomotic fistula.3.The ratio of neutrophil/lymphocyte on day 3 and day 5 after surgery was also significantly different between the two groups(P < 0.05),which was 8.4±4.0 and 5.3±2.4in the perineal drainage group,and significantly lower than that in the perineal drainage group,which was 11.6±10.2 and 8.7±8.1,respectively.There were also significant differences in C-reactive protein on day 3 and day 5 after surgery(P < 0.05),which were34.9±35.8 mg/L and 35.5±31.0 mg/L in the perineal drainage group,which were significantly lower than those in the perineal drainage group.The results were 51.7±45.0mg/L and 51.7±44.2 mg/L,respectively.Postoperative procalcitonin was 0.2±0.3 ng/m L in perineal drainage group and 0.7±0.8 ng/m L in abdominal drainage group,and there were significant differences between the two groups(P < 0.05).The number of white blood cells in the perineal drainage group was 7.1±1.9 ×10^9/L and that in the abdominal drainage group was 7.9±2.3×10^9/L,with significant difference(P < 0.05).4.LARS scores of patients in the perineal drainage tube group were 21.9±6.5,20.0±4.4and 18.8±4.3 one week,one month and three months after surgery,respectively.The results in the abdominal drainage tube group were 24.3±3.5,21.3±2.6,20.0±2.3,respectively.The two groups of patients showed common postoperative conditions of rectal cancer such as fecal discharge and increased frequency of defecation after surgery,and the scores in the two groups were significantly different from one week after surgery(P < 0.05).With the development of time,the two groups were improved,and the difference was not statistically significant.Gastrointestinal quality of life index(GIQLI)scores were 97.5±7.2 and 99.2±5.5 in the perineal drainage group 1 month and 3 months after surgery,and 93.2±7.9 and 97.4±5.1 in the perineal drainage group,respectively.At the first month of follow-up,there was no significant difference at 3 months after surgery.Conclusion: Transperineal sacral drainage is safe and feasible in laparoscopic assisted radical resection of rectal cancer,and its drainage effect is good,which has certain clinical value in the prevention and treatment of anastomotic fistula and short-term functional recovery. |
PDF Full Text Request