结肠切除术后吻合口裂开导致的术后腹膜炎。多中心经验、危险因素的回顾性分析及文献综述。

Post-operative peritonitis due to anastomotic dehiscence after colonic resection. Multicentric experience, retrospective analysis of risk factors and review of the literature.

作者信息

Ruggiero Roberto, Sparavigna Luigi, Docimo Giovanni, Gubitosi Adelmo, Agresti Massimo, Procaccini Eugenio, Docimo Lodovico

机构信息

Department of General Surgery, Second University of Naples, XT Division of General Surgery.

出版信息

Ann Ital Chir. 2011 Sep-Oct;82(5):369-75.

PMID:21988044

Abstract

INTRODUCTION

Intraperitoneal sepsis due to anastomotic leakage significantly affects the outcomes of intestinal surgery. The aim of this retrospective review is to examine retrospectively general and local factors involved in anastomotic leakage and their prognostic value.

MATERIALS AND METHODS

Between April 1998 and April 2008, 367 patients underwent elective (217=59%) or emergency (150=41%) primary colonic resection for benignan (77=21%) or malignant (290=79%) disease in our department. We performed the following operations; 124 right colon resections with immediate anastomoses (primary resection), 65 (52.4%) of which were emergency and 59 (47.6%) elective procedures; 171 left colon resections, 73 (42.7%) of which were emergency and 98 (57.3%) elective procedures, and 72 primary rectal resections, 12 (16.7%) of which were emergency and 60 (83.3%) elective procedures. The considered variables were stapled or manual anastomoses, protective stomas and medical comorbidities.

RESULTS

The perioperative mortality rate was 6.6% for emergency and 3.6% for elective procedures. The leak rate was 8.7% (32/367), 13.3% for emergency and 5.5% for elective procedures. Fistula was observed in 7/124 (5.6%) ileocolic, 13/171 (7.6%) colo-colic and 12/72 (16.6%) colo-rectal anastomoses, 8 of which were fashioned during emergency surgery. Twenty-one patients with anastomotic dehiscence were treated conservatively (3 underwent reoperation), while 11, with severe dehiscence, in all cases in the left colon, underwent an emergency Hartmann's procedure, with a perioperative mortality rate of 35.7%.

CONCLUSIONS

In our experience, the site of colonic anastomosis represents the risk factor most strictly related to the anastomotic leak rate, while other technical factors seem weakly associated with leakage. A significantly high percentage of patients (65.6%) with anastomotic fistulas have medical comorbidities.

摘要

引言

吻合口漏导致的腹腔内感染严重影响肠道手术的预后。本回顾性研究旨在回顾性分析与吻合口漏相关的全身和局部因素及其预后价值。

材料与方法

1998年4月至2008年4月期间，我科367例患者因良性（77例，占21%）或恶性（290例，占79%）疾病接受了择期（217例，占59%）或急诊（150例，占41%）的原发性结肠切除术。我们实施了以下手术：124例右半结肠切除并一期吻合（初次切除），其中65例（52.4%）为急诊手术，59例（47.6%）为择期手术；171例左半结肠切除，其中73例（42.7%）为急诊手术，98例（57.3%）为择期手术；72例直肠初次切除，其中12例（16.7%）为急诊手术，60例（83.3%）为择期手术。所考虑的变量包括吻合方式（吻合器或手工吻合）、保护性造口和合并症。

结果

急诊手术围手术期死亡率为6.6%，择期手术为3.6%。吻合口漏发生率为8.7%（32/367），急诊手术为13.3%，择期手术为5.5%。在回结肠吻合中观察到7例（5.6%）发生瘘，结肠结肠吻合中13例（7.6%），结肠直肠吻合中12例（16.6%），其中8例发生在急诊手术期间。21例吻合口裂开患者接受保守治疗（3例再次手术），而11例严重裂开患者，均发生在左半结肠，接受了急诊Hartmann手术，围手术期死亡率为35.7%。