Burch J M, Franciose R J, Moore E E, Biffl W L, Offner P J
Department of Surgery, Denver Health Medical Center, Denver, Colorado 80204-4507, USA.
Ann Surg. 2000 Jun;231(6):832-7. doi: 10.1097/00000658-200006000-00007.
To determine the suitability of a single-layer continuous technique for intestinal anastomosis in a surgical training program.
Several recent reports have advocated the use of a continuous single-layer technique for intestinal anastomosis. Purported advantages include shorter time for construction, lower cost, and perhaps a lower rate of anastomotic leakage. The authors hypothesized that the single-layer continuous anastomosis could be safely introduced into a surgical training program and that it could be performed in less time and at a lower cost than the two-layer interrupted anastomosis.
The study was conducted during a 3-year period ending September 1999. All adult patients requiring intestinal anastomosis were considered eligible. Patients who required anastomosis to the stomach, duodenum, and rectum were excluded. Patients were also excluded if the surgeon did not believe either technique could be used. Patients were randomly assigned to one- or two-layer techniques. Single-layer anastomoses were performed with a continuous 3-0 polypropylene suture. Two-layer anastomoses were constructed using interrupted 3-0 silk Lembert sutures for the outer layer and a continuous 3-0 polyglycolic acid suture for the inner layer. The time for anastomosis began with the placement of the first stitch and ended when the last stitch was cut. Anastomotic leak was defined as radiographic demonstration of a fistula or nonabsorbable material draining from a wound after oral administration, or visible disruption of the suture line during reexploration.
Sixty-five single-layer and 67 two-layer anastomoses were performed. The groups were evenly matched according to age, sex, diagnosis, and location of the anastomosis. Two leaks (3.1%) occurred in the single-layer group and one (1.5%) in the two-layer group. Two abscesses (3.0%) occurred in each group. A mean of 20.8 minutes was required to construct a single-layer anastomosis versus 30.7 minutes for the two-layer technique. Mean length of stay was 7.9 days for single-layer patients and 9.9 days for two-layer patients; this difference did not quite reach statistical significance. Cost of materials was $4.61 for the single-layer technique and $35.38 for the two-layer method.
A single-layer continuous anastomosis can be constructed in significantly less time and with a similar rate of complications compared with the two-layer technique. It also costs less than any other method and can be incorporated into a surgical training program without a significant increase in complications.
确定单层连续技术在外科培训项目中用于肠道吻合的适用性。
最近有几份报告提倡使用连续单层技术进行肠道吻合。据称其优点包括构建时间短、成本低，或许吻合口漏发生率也较低。作者推测单层连续吻合术可安全引入外科培训项目，且与双层间断吻合术相比，其操作时间更短、成本更低。
该研究在截至1999年9月的3年期间进行。所有需要进行肠道吻合的成年患者均被视为符合条件。需要进行胃、十二指肠和直肠吻合的患者被排除。如果外科医生认为两种技术均不可用，患者也被排除。患者被随机分配至单层或双层技术组。单层吻合使用连续的3-0聚丙烯缝线进行。双层吻合外层采用间断的3-0丝线伦伯特缝合法，内层采用连续的3-0聚乙醇酸缝线。吻合时间从第一针的置入开始，到最后一针剪断结束。吻合口漏的定义为口服后通过影像学显示有瘘管形成或伤口有不可吸收物质引流，或再次探查时可见缝线处裂开。
共进行了65例单层吻合和67例双层吻合。两组在年龄、性别、诊断和吻合部位方面匹配良好。单层组发生2例漏（3.1%），双层组发生1例漏（1.5%）。每组均发生2例脓肿（3.0%）。构建单层吻合平均需要20.8分钟，而双层技术需要30.7分钟。单层患者的平均住院时间为7.9天，双层患者为9.9天；这种差异未达到统计学意义。单层技术的材料成本为4.61美元，双层方法为35.38美元。
与双层技术相比，单层连续吻合术的构建时间显著更短，并发症发生率相似。其成本也低于其他任何方法，并且可以纳入外科培训项目，而不会显著增加并发症。
