Beard J D, Nicholson M L, Sayers R D, Lloyd D, Everson N W
Department of Surgery, Leicester Royal Infirmary, UK.
Br J Surg. 1990 Oct;77(10):1095-7. doi: 10.1002/bjs.1800771006.
A total of 145 consecutive patients receiving a colorectal anastomosis were randomized to 'test' or 'no test' once the anastomosis had been completed. Anastomotic testing was performed with the pelvis filled with saline and the rectum distended by sigmoidoscopic insufflation of air. Any leaks demonstrated were oversewn. A water-soluble contrast enema was performed on the tenth postoperative day. Seventy-four patients were randomized to 'test' and 71 to 'no test' but one patient was withdrawn from each group leaving a total of 143 for analysis. The two groups were well matched for age, sex, diagnosis and operative details. Eighteen (25 per cent) air leaks were detected and repaired in the 'test' group. After operation there were three (4 per cent) clinical leaks in the 'test' group and ten (14 per cent) in the 'no test' group (Fisher's exact test, P = 0.043). There were eight (11 per cent) radiological leaks in the 'test' group and 20 (29 per cent) in the 'no test' group (P = 0.006). Intraoperative air testing and repair of colorectal anastomoses significantly reduces the risk of postoperative clinical and radiological leaks.
共有145例接受结直肠吻合术的连续患者在吻合完成后被随机分为“测试组”或“非测试组”。吻合口测试在盆腔充满生理盐水且通过乙状结肠镜注气使直肠扩张的情况下进行。如有任何漏口被发现，则进行缝合。术后第10天进行水溶性造影剂灌肠。74例患者被随机分配至“测试组”，71例至“非测试组”，但每组各有1例患者退出，最终共有143例患者可供分析。两组在年龄、性别、诊断和手术细节方面匹配良好。“测试组”中检测到18例（25%）空气漏口并进行了修复。术后，“测试组”有3例（4%）临床漏口，“非测试组”有10例（14%）（Fisher精确检验，P = 0.043）。“测试组”有8例（11%）影像学漏口，“非测试组”有20例（29%）（P = 0.006）。结直肠吻合术中进行空气测试和修复可显著降低术后临床和影像学漏口的风险。
