Department of Surgery, Odense University Hospital, Odense C, Denmark.
Scand J Surg. 2009;98(3):148-54. doi: 10.1177/145749690909800304.
The aim of the present study was to evaluate the efficacy and safety of intraperitoneal microdialysis in early detection of anastomotic leakage after low anterior resection for rectosigmoid cancer.
In a series of 116 consecutive patients scheduled for low anterior resection for rectosigmoid cancer, a total of 50 patients consented to participate. Peritoneal microdialysis was performed by a 1 mm thin catheter anchored in close proximity to the anastomosis. Five patients were excluded due to catheter malfunction. Average microdialysis time in the remaining 45 patients was 177.6 (80-252) hours. Samples were collected every 4-hours, and the concentration of glucose, lactate, pyruvate and glycerol was measured.
Four patients developed symptomatic anastomotic leakage. Two patients developed non-abdominal sepsis. In 38 patients the postoperative course was uncomplicated, considering major complications, and they served as controls. In three patients with late (>or=10 days) anastomotic leakage a significant increase in concentration of lactate and lactate/pyruvate ratio (L/P-ratio) was seen several days prior to development of clinical symptoms. In one patient with early anastomotic leakage it coincided with the development of clinical symptoms. In the two patients with non-abdominal sepsis the values were within normal range.
Peritoneal microdialysis is a safe and promising tool in early diagnosis of anastomotic leakage after low anterior resection for rectosigmoid cancer.
本研究旨在评估腹腔内微透析在检测直肠乙状结肠癌低位前切除术后吻合口漏中的作用。
对 116 例拟行直肠乙状结肠癌低位前切除术的患者进行了系列研究，其中 50 例患者同意参加。通过一根锚定在吻合口附近的 1mm 细导管进行腹腔内微透析。由于导管功能障碍，有 5 例患者被排除。在其余 45 例患者中，平均微透析时间为 177.6（80-252）小时。每 4 小时采集一次样本，测量葡萄糖、乳酸、丙酮酸和甘油的浓度。
4 例患者出现症状性吻合口漏，2 例患者出现非腹部脓毒症。38 例患者术后无并发症，考虑主要并发症，作为对照组。在 3 例迟发性（>或=10 天）吻合口漏的患者中，在出现临床症状前几天，乳酸和乳酸/丙酮酸比值（L/P 比值）的浓度显著升高。在 1 例早期吻合口漏的患者中，它与临床症状的发展相一致。在 2 例非腹部脓毒症患者中，值在正常范围内。
腹腔内微透析是直肠乙状结肠癌低位前切除术后早期诊断吻合口漏的一种安全、有前途的工具。
