Department of Surgery, University of Alexandria, Alexandria, Egypt.
Dis Colon Rectum. 2010 Jun;53(6):889-95. doi: 10.1007/DCR.0b013e3181d3206e.
The leak rate after low anterior resection is in the region of 10% to 15%. The highest risks of anastomotic leak are in anastomoses less than 5 cm from the anal verge. We evaluated the outcome of oxidized regenerated cellulose reinforcement of low rectal anastomosis.
The study group consisted of 108 patients with rectal cancer. Patients with low rectal cancer had low anterior resection with stapled straight low colorectal or coloanal anastomosis without proximal diversion. They were prospectively randomized to either oxidized regenerated cellulose reinforcement or no reinforcement. Data collected included age, sex, hemoglobin percentage, albumin level, histopathologic type of the tumor, anastomotic leak, and stricture.
The mean age of patients was 56 years, and sex was matched in both groups. Clinical leak occurred in 6 of 38 cases (15.7%) in the group that did not undergo reinforcement versus 2 of 33 (6.1%) in the oxidized regenerated cellulose reinforcement group (P < .01). In the case of a leak, diversion was needed in 3 of 6 patients in the group that did not undergo reinforcement vs no patients in the oxidized regenerated cellulose reinforcement group (P = .05). Generalized peritonitis occurred in 3 patients in the group that did not undergo reinforcement versus no patients in the oxidized regenerated cellulose reinforcement group (P < .01). Length of stay was 4.8 days in the oxidized regenerated cellulose reinforcement group versus 5.9 days in the group that did not undergo reinforcement (P = .047), with no mortalities in either group.
Oxidized regenerated cellulose reinforcement of low rectal anastomosis significantly decreases the risk of postoperative leak in low rectal anastomosis and may reduce the requirement for proximal diversion. Potential benefits include avoidance of a stoma, lower morbidity, shorter hospital stay, and a lower cost of care.
低位前切除术后的漏率在 10%至 15%之间。吻合口漏的最高风险发生在距离肛缘小于 5cm 的吻合处。我们评估了氧化再生纤维素强化低位直肠吻合术的结果。
研究组包括 108 例直肠癌患者。低位直肠癌患者行低位前切除术，采用吻合器吻合直结直肠或结肠直肠吻合术，不进行近端转流。他们被前瞻性随机分为氧化再生纤维素强化组或无强化组。收集的数据包括年龄、性别、血红蛋白百分比、白蛋白水平、肿瘤的组织病理学类型、吻合口漏和狭窄。
患者的平均年龄为 56 岁，两组的性别匹配。未进行强化组的 38 例中有 6 例（15.7%）发生临床漏，而氧化再生纤维素强化组的 33 例中有 2 例（6.1%）（P<.01）。在发生漏的情况下，未进行强化组的 3 例患者需要转流，而氧化再生纤维素强化组没有患者需要转流（P=0.05）。未进行强化组有 3 例患者发生弥漫性腹膜炎，而氧化再生纤维素强化组没有患者发生（P<.01）。氧化再生纤维素强化组的住院时间为 4.8 天，而未进行强化组为 5.9 天（P=0.047），两组均无死亡病例。
氧化再生纤维素强化低位直肠吻合术可显著降低低位直肠吻合术后漏的风险，并可能减少近端转流的需求。潜在的益处包括避免造口、降低发病率、缩短住院时间和降低医疗费用。
