Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
Am J Surg. 2011 Sep;202(3):259-64. doi: 10.1016/j.amjsurg.2010.11.014.
Laparoscopic rectal cancer surgery involving rectal division with intracorporeal stapling devices is technically difficult. This study aimed to identify risk factors for anastomotic leakage associated with laparoscopic anterior resection for rectal cancer.
We studied 363 patients who underwent laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique (DST) anastomosis for rectal cancer between July 2005 and February 2010. Twenty-two independent clinical variables were examined by univariate and multivariate analyses. The outcome of interest was clinical anastomotic leakage.
Anastomotic leakage was identified in 13 (3.6%) patients. Multivariate analysis identified middle/lower rectal cancer (odds ratio, 9.446) and lack of pelvic drain (odds ratio, 3.814) as independent predictive factors for anastomotic leakage. The number of cartridges used for rectal division had no significant impact on anastomotic leakage.
Laparoscopic anterior resection involving intracorporeal rectal transection and DST anastomosis is safe if performed using an appropriate technique.
涉及使用管腔内吻合器进行直肠分离的腹腔镜直肠癌手术在技术上具有一定难度。本研究旨在确定与腹腔镜直肠癌前切除术相关的吻合口漏的危险因素。
我们研究了 2005 年 7 月至 2010 年 2 月期间 363 例接受腹腔镜直肠癌前切除术且采用管腔内直肠横断和双吻合器技术（DST）吻合的直肠癌患者。通过单因素和多因素分析检查了 22 个独立的临床变量。研究的结局是临床吻合口漏。
13 例（3.6%）患者发生吻合口漏。多因素分析确定中/低位直肠癌（比值比，9.446）和缺乏盆腔引流（比值比，3.814）是吻合口漏的独立预测因素。直肠分离使用的钉匣数量对吻合口漏无显著影响。
如果采用适当的技术，腹腔镜直肠癌前切除术涉及管腔内直肠横断和 DST 吻合是安全的。
