Harvey Elizabeth H, Young Michelle R, Flanigan Thomas L, Carlin Arthur M, White Michael T, Tyburski James G, Weaver Donald W
Department of Surgery, Wayne State University, Detroit, Michigan, USA.
Am Surg. 2004 Mar;70(3):193-6; discussion 197.
The Kraske procedure offers a sphincter-saving alternative for surgical correction of rectal disease. This study was performed to investigate the complication rate with the traditional (transsacral) Kraske procedure versus an abdominal-assisted Kraske approach (laparoscopic or open). We conducted a retrospective review of all patients undergoing the Kraske procedure at Harper University Hospital over a 10-year period. A total of 54 patients were identified. Indications for surgery included rectal carcinoma (43), large villous adenomas (6), and other (5). Average post-operative follow-up was 40 +/- 25 months (mean +/- SD). Complications included rectocutaneous fistulae (9), perineal infections (13), and incontinence (8). In patients requiring an abdominal-assisted approach for colorectal mobilization, the fistula rate was significantly higher (33% vs 3%; P = 0.007), as were the rates of perineal infections (33% vs 17%) and of initial incontinence (25% vs 7%). The laparoscopic-assisted approach significantly reduced the operating time (272 +/- 72 minutes) compared to the open-assisted approach (498 +/- 138 minutes) (P < 0.001). The traditional Kraske procedure can be utilized in a safe, effective manner for treatment of rectal disease. Knowledge of the increased rate of complications with the abdominal-assisted Kraske approach can guide the patient and physician considering sphincter salvage.
克拉斯克手术为直肠疾病的手术矫正提供了一种保留括约肌的替代方法。本研究旨在调查传统（经骶骨）克拉斯克手术与腹部辅助克拉斯克手术（腹腔镜或开放手术）的并发症发生率。我们对哈珀大学医院10年间接受克拉斯克手术的所有患者进行了回顾性研究。共确定了54例患者。手术适应症包括直肠癌（43例）、大绒毛状腺瘤（6例）和其他疾病（5例）。术后平均随访时间为40±25个月（均值±标准差）。并发症包括直肠皮肤瘘（9例）、会阴感染（13例）和失禁（8例）。在需要腹部辅助方法进行结肠直肠游离的患者中，瘘管发生率显著更高（33%对3%；P = 0.007），会阴感染率（33%对17%）和初始失禁率（25%对7%）也是如此。与开放辅助手术（498±138分钟）相比，腹腔镜辅助手术显著缩短了手术时间（272±72分钟）（P < 0.001）。传统的克拉斯克手术可以安全、有效地用于治疗直肠疾病。了解腹部辅助克拉斯克手术并发症发生率的增加情况可以指导考虑保留括约肌的患者和医生。
