ABSTRACT
Objective: To assess the effectiveness of transanal drainage tube (TDT) in reducing the incidence of anastomotic leak following anterior resection in patients with rectal cancer. Methods: We conducted a systematic search for relevant studies published from inception to October 2022 across multiple databases, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP. Meta-analysis was performed using Review Manager 5.4 software. The primary outcomes included total incidence of anastomotic leak, grade B and C anastomotic leak rates, reoperation rate, anastomotic bleeding rate, and overall complication rate. Results: Three randomized controlled trials involving 1115 patients (559 patients in the TDT group and 556 in the non-TDT group) were included. Meta-analysis showed that the total incidences of anastomotic leak and of grade B anastomotic leak were 5.5% (31/559) and 4.5% (25/559), respectively, in the TDT group and 7.9% (44/556) and 3.8% (21/556), respectively, in the non-TDT group. These differences are not statistically significant (P=0.120, P=0.560, respectively). Compared with the non-TDT group, the TDT group had a lower incidence of grade C anastomotic leak (1.6% [7/559] vs. 4.5% [25/556]) and reoperation rate (0.9% [5/559] vs. 4.3% [24/556]), but a higher incidence of anastomotic bleeding (8.2% [23/279] vs. 3.6% [10/276]). These differences were statistically significant (P=0.003, P=0.001, P=0.030, respectively). The overall complication rate was 26.5%(74/279) in the TDT group and 27.2% (75/276) in the non-TDT group. These differences are not statistically significant (P=0.860). Conclusions: TDT did not significantly reduce the total incidence of anastomotic leak but may have potential clinical benefits in preventing grade C anastomotic leak. Notably, placement of TDT may increase the anastomotic bleeding rate.
Subject(s)
Humans , Anastomotic Leak/etiology , Rectal Neoplasms/complications , Drainage , Anastomosis, Surgical/adverse effects , Reoperation/adverse effects , Hemorrhage , Retrospective StudiesABSTRACT
Objective:To observe clinical effect of addition and subtraction therapy of Si Junzitang combined with Simotang to outlet obstructive constipation (OOC) after stapled trans-anal rectal resection (STARR). Method:One hundred and twenty-four patients were randomly divided into control group (62 cases) and observation group (62 cases) by random number table. Patients in control group got Qirong Ruichang oral liquid, 20 mL/time, 3 times/day. After operation, patients in observation group got addition and subtraction therapy of Si Junzitang combined with Simotang, 1 dose/day. And courses of treatment in two groups were 4 weeks, and 8 weeks' follow-up was recorded. Before the operation and at the second and fourth week after treatment, and the eighth week of follow-up, scores of main symptoms of constipation and Longo ODS were graded. Before the operation and at the fourth week after treatment, levels of superoxide dismutase (SOD), malondialdehyde (MDA), constipation patients quality of life self-assessment scale (PAC-QOL), anorectal pressure, anal resting pressure (ARP), maximum anal systolic pressure (MSP), rectal defecation pressure (RSP), FSV, CRS and MTV were recorded. And incidence, recurrence, normal defecation, satisfaction at the fourth week after the operation and safety were evaluated. Result:The clinical rate in observation group was better than that in control group (Z=2.096, P<0.05). At the second, fourth after treatment and eigh weeks' for follow-up, score of main symptoms of constipation and Longo ODS were both lower than those in control group (P<0.01). Levels of ARP, FSV, FSV, CRS and MDA were lower than those in control group (P<0.01), levels of MSP, RSP and SOD were higher than those in control group (P<0.01). Incidence and recurrence rate in observation group were 20.97% (13/62) and 4.84% (3/62) were all lower than 39.71% (24/62) and 16.13% (10/62) in control group (P<0.05). Normal defecation rate in observation group was 91.94% (57/62) higher than 80.65% (50/62) in control group, but there was no statistical significance in two groups. And total score of PAC-QOL and scores of each factor were all lower than those in control group (P<0.01). Then there was no adverse reaction related to the traditional Chinese medicine. Conclusion:Addition and subtraction therapy of Si Junzitang combined with Simotang can reduce constipation symptoms and the degree of illness, improve the quality of life, reduce the incidence of postoperative complications and recurrence rate, and improve anorectal dynamic indicators and oxidative stress indicators, improve the clinical efficacy.