Lim Michael, Akhtar Saleem, Sasapu Kishore, Harris Keith, Burke Dermot, Sagar Peter, Finan Paul
Department of Colorectal Surgery, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom.
Dis Colon Rectum. 2006 Oct;49(10):1611-9. doi: 10.1007/s10350-006-0663-6.
This study was designed to examine the natural history of subclinical leaks and their effect on bowel function and quality of life and to evaluate water-soluble contrast enema features that predict anastomotic healing after leaks.
Consecutive patients who underwent low rectal anastomosis were followed up postoperatively for leaks. All leaks were confirmed radiologically with CT scanning and water-soluble contrast enema imaging. Water-soluble contrast enemas were serially repeated to identify healing. Characteristics on initial water-soluble contrast enema were correlated with observed healing. Postoperatively, patients were required to fill in a quality of life and a bowel function questionnaire.
A total of 138 patients underwent low rectal anastomosis procedures with a median follow-up period of 26 (interquartile range, 19-37) months. There were 23 documented leaks of which 13 (9 percent) presented clinically and 10 (8 percent) presented subclinically. Ileostomy closure was possible in 4 of 13 (30 percent) patients with a clinical leak and all 10 (100 percent) patients with a subclinical leak. Median quality of life scores were lower for patients with clinical leaks and no ileostomy closure (P = 0.03). Bowel function for subclinical leak patients and clinical leak patients with ileostomy closure were similarly impaired. The presence of a cavity (P = 0.01) and a stricture (P = 0.01) at the anastomotic site were unfavorable radiologic features associated with nonhealing.
Subclinical leaks are more benign in their natural history compared with clinical leaks. Quality of life and bowel function is no better in patients with a subclinical leak compared with patients with a clinical leak who have ileostomy closure. Anastomotic leaks may resolve if favorable radiologic features are present.
本研究旨在探讨亚临床渗漏的自然病程及其对肠道功能和生活质量的影响，并评估预测渗漏后吻合口愈合的水溶性造影剂灌肠特征。
对连续接受低位直肠吻合术的患者进行术后渗漏随访。所有渗漏均通过CT扫描和水溶性造影剂灌肠成像进行影像学确认。连续重复进行水溶性造影剂灌肠以确定愈合情况。初始水溶性造影剂灌肠的特征与观察到的愈合情况相关。术后，要求患者填写生活质量和肠道功能问卷。
共有138例患者接受了低位直肠吻合术，中位随访期为26（四分位间距，19 - 37）个月。记录到23例渗漏，其中13例（9%）为临床显性渗漏，10例（8%）为亚临床渗漏。13例临床显性渗漏患者中有4例（30%）可行回肠造口关闭术，10例亚临床渗漏患者均（100%）可行回肠造口关闭术。临床显性渗漏且未行回肠造口关闭术的患者生活质量评分中位数较低（P = 0.03）。亚临床渗漏患者和行回肠造口关闭术的临床显性渗漏患者的肠道功能同样受损。吻合口处存在腔隙（P = 0.01）和狭窄（P = 0.01）是与不愈合相关的不良影像学特征。
与临床渗漏相比，亚临床渗漏的自然病程更为良性。与行回肠造口关闭术的临床渗漏患者相比，亚临床渗漏患者的生活质量和肠道功能并无更好。如果存在有利的影像学特征，吻合口渗漏可能会自行缓解。
