Suding Paul, Jensen Erin, Abramson Murray A, Itani Kamal, Wilson Samuel Eric
University of California-Irvine, Orange, CA 92868, USA.
Arch Surg. 2008 Sep;143(9):907-11; discussion 911-2. doi: 10.1001/archsurg.143.9.907.
Anastomotic leaks following elective colorectal resections increase morbidity, mortality, and the need for additional interventions. An accurate understanding of risk factors would potentially reduce anastomotic leaks and/or allow appropriate selection of patients for diverting stomas.
Prospective review of patient and operative characteristics that contribute to anastomotic leaks.
Fifty-one sites within the United States (May 2002-March 2005).
Six hundred seventy-two patients who participated in a trial comparing preoperative antimicrobials in elective open colorectal surgery.
Anastomotic leaks were diagnosed using clinical findings and were confirmed with imaging. We examined 20 variables possibly affecting anastomotic healing in univariate and multivariate analyses.
There were 24 anastomotic leaks in 672 patients (3.6%) undergoing elective colorectal resection. There were 10 deaths (1.5%). A baseline albumin level of less than 3.5 g/dL (to convert to grams per liter, multiply by 10) (P = .04) and male sex (P = .03) were associated with anastomotic leaks in both univariate and multivariate analyses (adjusted odds ratios, 2.56 and 3.12, respectively). Increased duration of surgery (SD, 60 minutes; odds ratio, 1.53; 95% confidence interval, 1.06-2.22; P = .03) and steroid use at the time of surgery (odds ratio, 3.85; 95% confidence interval, 1.24-11.93; P = .02) were significant in univariate analysis. Surgical procedure with rectal resection; prophylaxis with ertapenem (vs cefotetan); or history of obesity, tobacco use, or diabetes was not associated with anastomotic leaks.
Significant risk factors for anastomotic leaks include low preoperative serum albumin level, steroid use, male sex, and increased duration of surgery. Appreciation of risk factors provides a rational basis for temporary diversion.
择期结直肠切除术后吻合口漏会增加发病率、死亡率以及额外干预的需求。准确了解危险因素可能会减少吻合口漏和/或有助于为患者选择合适的转流造口术。
对导致吻合口漏的患者及手术特征进行前瞻性评估。
美国的51个地点（2002年5月至2005年3月）。
672名参与择期开放性结直肠手术术前抗菌药物比较试验的患者。
根据临床发现诊断吻合口漏，并通过影像学检查确诊。我们在单因素和多因素分析中研究了20个可能影响吻合口愈合的变量。
672例接受择期结直肠切除术的患者中有24例发生吻合口漏（3.6%）。有10例死亡（1.5%）。在单因素和多因素分析中，术前白蛋白水平低于3.5 g/dL（换算为克每升时乘以10）（P = 0.04）和男性（P = 0.03）均与吻合口漏相关（校正比值比分别为2.56和3.12）。手术时间延长（标准差60分钟；比值比1.53；95%置信区间1.06 - 2.22；P = 0.03）和手术时使用类固醇（比值比3.85；95%置信区间1.24 - 11.93；P = 0.02）在单因素分析中具有统计学意义。直肠切除手术、使用厄他培南预防（对比头孢替坦）、肥胖史、吸烟史或糖尿病史与吻合口漏无关。
吻合口漏的重要危险因素包括术前血清白蛋白水平低、使用类固醇、男性以及手术时间延长。认识这些危险因素为临时转流提供了合理依据。
