Lian Lei, Kiran Ravi P, Remzi Feza H, Lavery Ian C, Fazio Victor W
Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Dis Colon Rectum. 2009 Mar;52(3):387-93. doi: 10.1007/DCR.0b013e31819ad4f2.
Outcomes for patients developing a leak after ileal pouch-anal anastomosis have not been well investigated. This study explored whether the use of a stapled or handsewn anastomosis was associated with different outcomes when an anastomotic leak developed.
Patients were identified from a prospectively maintained pouch database. Functional outcomes regarding bowel movements, urgency, continence, and seepage were evaluated. Quality of life was assessed by the Cleveland Global Quality of Life Score.
One hundred and seventy-five patients with anastomotic leak (141 stapled and 34 handsewn anastomosis) were identified. The two groups were similar in gender and diagnosis. Patients with handsewn anastomosis were younger (P = 0.04), had less perioperative steroid use (P = 0.05), more proximal diversion (P = 0.02), and S-pouch creation (P = 0.003). More handsewn cases had intraoperative transfusion (P = 0.04) and postoperative hemorrhage within the pelvis (P = 0.003). Long-term pouch failure was 35.3 percent in the handsewn group and 12 percent in the stapled group (P = 0.002), which was confirmed by Kaplan-Meier analysis (Log-rank P = 0.007). On multivariate analysis, leak after handsewn anastomosis was independently associated with pouch failure. Leak after stapled anastomosis carried a lower incontinence rate at 5 years (P = 0.03), while handsewn had higher nocturnal seepage rate at 3, 5, and 10 years, and most recent follow-up. Cleveland Global Quality of Life Score was comparable between the groups during follow-up.
Outcomes including functional results and pouch failure rates for patients developing a leak after stapled anastomosis at ileal pouch-anal anastomosis were significantly better than outcomes for patients who develop a leak after handsewn anastomosis.
回肠储袋肛管吻合术后出现吻合口漏的患者的预后尚未得到充分研究。本研究探讨了在发生吻合口漏时，使用吻合器吻合或手工缝合吻合是否与不同的预后相关。
从一个前瞻性维护的储袋数据库中识别患者。评估了排便、急迫感、控便和渗漏方面的功能结局。通过克利夫兰全球生活质量评分评估生活质量。
识别出175例吻合口漏患者（141例使用吻合器吻合，34例手工缝合吻合）。两组在性别和诊断方面相似。手工缝合吻合的患者更年轻（P = 0.04），围手术期使用类固醇较少（P = 0.05），近端转流更多（P = 0.02），并且创建S形储袋更多（P = 0.003）。更多手工缝合病例有术中输血（P = 0.04）和盆腔内术后出血（P = 0.003）。手工缝合组的长期储袋失败率为35.3%，吻合器吻合组为12%（P = 0.002），这通过Kaplan-Meier分析得到证实（对数秩P = 0.007）。多因素分析显示，手工缝合吻合后的漏与储袋失败独立相关。吻合器吻合后的漏在5年时失禁率较低（P = 0.03），而手工缝合在3年、5年和10年以及最近一次随访时夜间渗漏率较高。随访期间两组的克利夫兰全球生活质量评分相当。
在回肠储袋肛管吻合术中，吻合器吻合后发生漏的患者的结局，包括功能结果和储袋失败率，明显优于手工缝合吻合后发生漏的患者。
