Wrighton Lindsay, Curtis Jennifer L, Gollin Gerald
Division of Pediatric Surgery, Loma Linda University School of Medicine and Children's Hospital, Loma Linda, CA 92354, USA.
J Pediatr Surg. 2008 Dec;43(12):2231-4. doi: 10.1016/j.jpedsurg.2008.08.052.
We reviewed our experience with stapled intestinal anastomoses in infants younger than 1 year and compared operative data and outcome to that of infants who underwent hand-sewn anastomoses.
Infants younger than 1 year who underwent an intestinal anastomosis over an 8-year period were identified. Stapled anastomoses were constructed in a side-to-side fashion using standard or endoscopic linear cutters. Outcome variables including operative time, anastomotic failure, and death were recorded.
Two hundred ninety-five subjects were identified. Hand-sewn anastomoses were performed in 189 cases and stapled anastomoses in 106. Patients who had a stapled anastomosis were older (105 vs 44 days) and larger (5.2 vs 3.1 kg), although 25 stapled anastomoses were performed in infants between 600 and 1000 g. When a stapled anastomosis was used operative time was significantly reduced overall (102 vs 128 minutes) and for individual procedures including resection for necrotizing enterocolitis (85 vs 132 minutes) and colostomy closure (104 vs 141 minutes). There was no difference between hand-sewn and stapled anastomoses in the incidence of adhesive obstruction, stricture, or leak.
When permitted by intestinal size in infants younger than 1 year, stapled anastomoses were safe and effective and significantly reduced operative time.
我们回顾了1岁以下婴儿使用吻合器进行肠道吻合术的经验，并将手术数据和结果与接受手工缝合吻合术的婴儿进行了比较。
确定在8年期间接受肠道吻合术的1岁以下婴儿。使用标准或内镜直线切割器以侧对侧方式构建吻合器吻合。记录包括手术时间、吻合失败和死亡在内的结果变量。
共确定了295名受试者。189例进行了手工缝合吻合术，106例进行了吻合器吻合术。进行吻合器吻合术的患者年龄较大（105天对44天）且体重较重（5.2 kg对3.1 kg），尽管在600至1000 g的婴儿中进行了25例吻合器吻合术。使用吻合器吻合术时，总体手术时间显著缩短（102分钟对128分钟），包括坏死性小肠结肠炎切除术（85分钟对132分钟）和结肠造口关闭术（104分钟对141分钟）等个别手术的时间也显著缩短。手工缝合吻合术和吻合器吻合术在粘连性肠梗阻、狭窄或渗漏发生率方面没有差异。
对于1岁以下婴儿，在肠道大小允许的情况下，吻合器吻合术安全有效，且显著缩短了手术时间。
