Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Surgery. 2010 Mar;147(3):339-51. doi: 10.1016/j.surg.2009.10.012. Epub 2009 Dec 11.
Anastomotic leakage represents a major complication after anterior resection of the rectum. The incidence of anastomotic leakage varies considerably among clinical studies in part owing to the lack of a standardized definition of this complication. The aim of the present article was to propose a definition and severity grading of anastomotic leakage after anterior rectal resection.
After a literature review a consensus definition and severity grading of anastomotic leakage was developed within the International Study Group of Rectal Cancer.
Anastomotic leakage should be defined as a defect of the intestinal wall at the anastomotic site (including suture and staple lines of neorectal reservoirs) leading to a communication between the intra- and extraluminal compartments. Severity of anastomotic leakage should be graded according to the impact on clinical management. Grade A anastomotic leakage results in no change in patients' management, whereas grade B leakage requires active therapeutic intervention but is manageable without re-laparotomy. Grade C anastomotic leakage requires re-laparotomy.
The proposed definition and clinical grading is applicable easily in the setting of clinical studies. It should be applied in future reports to facilitate valid comparison of the results of different studies.
吻合口漏是直肠前切除术后的主要并发症。由于缺乏对这种并发症的标准化定义，吻合口漏在临床研究中的发生率差异很大。本文旨在提出直肠前切除术后吻合口漏的定义和严重程度分级。
在文献复习的基础上，国际直肠癌研究小组达成了吻合口漏的共识定义和严重程度分级。
吻合口漏应定义为吻合部位肠壁的缺陷（包括新直肠储袋的缝合线和订书钉线）导致腔内外腔之间的沟通。吻合口漏的严重程度应根据对临床管理的影响进行分级。A级吻合口漏不会改变患者的治疗方案，而 B 级漏需要积极的治疗干预，但无需再次剖腹手术即可控制。C 级吻合口漏需要再次剖腹手术。
提出的定义和临床分级在临床研究中易于应用。它应该在未来的报告中应用，以便于比较不同研究的结果。
