Stumpf M, Klinge U, Mertens P R
Chirurgische Klinik, Universitätsklinikum der RWTH Aachen.
Chirurg. 2004 Nov;75(11):1056-62. doi: 10.1007/s00104-004-0956-z.
Anastomotic leakage is still a serious complication in surgery, resulting in increased morbidity and mortality. The reasons for its onset are various and due to two main reasons: general risk factors of the individual patient and technical surgical factors influencing the outcome after gastrointestinal anastomoses. Changes in the extracellular matrices, particularly due to collagen metabolism, and related disturbances are assumed to be important factors influencing wound healing processes. The technique chosen and the surgical skill are important with regard to inflammation and tissue necroses at the anastomotic line. Analysis of data obtained by clinical studies that concern clinical risk factors for anastomotic leakage reveal an inhomogeneous picture. Attempts to develop risk profiles or scores based on these results have failed until now. Problems encompass the complexity of wound healing processes, and it is questionable whether our current knowledge about them is complete. Therefore, profound understanding of anastomotic leakage requires in-depth analysis of the interaction of extracellular matrix components. Preliminary results indicate the presence of a risk population with collagen metabolism disturbances that have a major effect on wound healing after gastrointestinal anastomosis.
吻合口漏仍是手术中的一种严重并发症，会导致发病率和死亡率增加。其发病原因多种多样，主要有两个原因：个体患者的一般风险因素以及影响胃肠吻合术后结果的手术技术因素。细胞外基质的变化，特别是由于胶原代谢引起的变化以及相关紊乱，被认为是影响伤口愈合过程的重要因素。所选技术和手术技巧对于吻合口处的炎症和组织坏死至关重要。对涉及吻合口漏临床风险因素的临床研究所得数据的分析显示情况并不一致。基于这些结果开发风险概况或评分的尝试至今均告失败。问题包括伤口愈合过程的复杂性，而且我们目前对它们的了解是否完整也值得怀疑。因此，要深入了解吻合口漏，需要对细胞外基质成分之间的相互作用进行深入分析。初步结果表明存在一群胶原代谢紊乱的风险人群，他们对胃肠吻合术后的伤口愈合有重大影响。
