Efficacy Of Transanal Drainage Tube And Self-expanding Metallic Stent In Acute Left Malignant Colorectal Obstruction

Objective:To compare the curative effect of transanal drainage tube(TDT)with self-expanding metallic stent(SEMS)in acute left malignant colorectal obstructions.Methods: This is a retrospective study including patients with acute left malignant colorectal obstruction who underwent TDT or SEMS placement for the palliation of dysphagia from December 2014 to October 2017.Compare the two groups with the rate of operative success,obstruction relief,complications and hypokalemia.The postoperative oral intake time,after surgery indicators and hospital expenses were also compared.Results:The technical success rates of TDT group and SEMS group were 95.6% and97.1% respectively,and the rates of obstruction relief were 86.6% and 92.8%respectively.There were 4 cases with re-obstruction,4 cases with catheter displacement and 1 case with perforation in TDT group.In the SEMS group,2 cases with re-obstruction and 1 case with stent were displaced,2 cases with diffuse peritonitis and 1case with perforation occurred after stenting.TDT was more easily translocated than SEMS(P = 0.02),and there was no significant difference in the incidence of other complications.The oral intake time was 8.1 ± 3.8 days and 2.4 ± 1.5 days respectively(P = 0.00).Subsequently,there were 44 patients and 72 patients took resection surgery in TDT group and SEMS group,the direct anastomosis rates were 63.6% and 73.6%(P =0.26),only 1 case of TDT group had anastomotic leakage.The operation time was 194.4± 75.9 minutes and 162.0 ± 56.8 minutes in TDT group and SEMS group respectively(P= 0.01).The postoperative hospital stay was 13.0(10.3,17.0)days and 12.0(11.0,15.0)days(P = 1.00).The total treatment costs for patients undergoing surgery in the TDT and SEMS groups were 84,547 yuan and 87,562 yuan(P=0.26).Conclusion:Both TDT and SEMS can effectively relieve acute left malignant colorectal obstruction with safe and reliable results,and they can both reduce the ostomy rate compared with traditional surgery.SEMS could alleviate obstruction faster than TDT.