Brundage S I, Jurkovich G J, Grossman D C, Tong W C, Mack C D, Maier R V
Department of Surgery, The University of Washington, Seattle, USA.
J Trauma. 1999 Sep;47(3):500-7; discussion 507-8. doi: 10.1097/00005373-199909000-00011.
Construction of gastrointestinal anastomoses by using stapling devices has become a familiar procedure. Most studies have shown no significant differences in complication rates between stapled and sutured anastomoses performed during elective surgery. To date, no study has evaluated the incidence of complications of stapled anastomoses in the trauma patient. The purpose of our study was to determine whether the incidence of postoperative complications differs between stapled and sutured anastomoses after the emergent repair of traumatic bowel injuries.
A retrospective analysis of the medical and institutional trauma registry records of patients identified to have undergone a gastrointestinal anastomosis in a regional Level I trauma center over a 4-year period.
A total of 84 patients with 118 gastrointestinal anastomoses were identified. A surgical stapling device was used to create 58 separate anastomoses, whereas a hand-sutured method was used in 60 anastomoses. A complication was defined as an anastomotic leak verified at reoperation. The ratio of blunt versus penetrating injuries, mean abdominal Abbreviated Injury Scale score, and Injury Severity Score were similar in the two groups. Stapling and suturing techniques were evenly distributed between small and large bowel repairs. Mean intensive care unit length of stay was comparable in both cohorts. However, inpatient length of stay was longer in patients with solely a stapled anastomosis compared with sutured anastomoses. Four of the 58 stapled anastomoses and none of the 60 hand-sewn anastomoses resulted in a clinically significant leak requiring reoperation (relative risk = undefined; 95% confidence interval, 1.14-infinity; p = 0.037). Each anastomotic leak occurred in a separate individual. The only death occurred in the stapled cohort secondary to peritonitis and subsequent sepsis.
Anastomotic leaks seem to be associated with stapled bowel repairs compared with sutured anastomoses in the traumatically injured patient.
使用吻合器构建胃肠道吻合术已成为一种常见的手术操作。大多数研究表明，择期手术中吻合器吻合和缝线吻合的并发症发生率无显著差异。迄今为止，尚无研究评估创伤患者中吻合器吻合的并发症发生率。我们研究的目的是确定创伤性肠损伤急诊修复后，吻合器吻合和缝线吻合的术后并发症发生率是否存在差异。
对某地区一级创伤中心4年内接受胃肠道吻合术的患者的医疗和机构创伤登记记录进行回顾性分析。
共识别出84例患者，有118例胃肠道吻合术。使用手术吻合器进行了58例单独的吻合，而60例吻合采用手工缝合方法。并发症定义为再次手术时证实的吻合口漏。两组钝性伤与穿透伤的比例、平均腹部简明损伤量表评分和损伤严重程度评分相似。吻合器和缝合技术在小肠和大肠修复中分布均匀。两个队列的平均重症监护病房住院时间相当。然而，单纯吻合器吻合的患者住院时间比缝线吻合的患者更长。58例吻合器吻合中有4例出现临床显著漏，需要再次手术，而60例手工缝合吻合中无一例出现这种情况（相对风险=未定义；95%置信区间，1.14-无穷大；p=0.037）。每个吻合口漏均发生在不同个体。唯一的死亡发生在吻合器吻合组，继发于腹膜炎和随后的脓毒症。
在创伤患者中，与缝线吻合相比，吻合器肠修复似乎与吻合口漏有关。
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