Palmisano Silvia, Piccinni Giuseppe, Casagranda Biagio, Balani Alessandro, de Manzini Nicolò
Department of Surgery, University of Trieste and Cattinara Hospital, Strada di Fiume, Trieste, Italy.
Am Surg. 2011 Dec;77(12):1619-23.
A proximal diverting stoma is recommended in "high-risk" conditions after total mesorectal excision. The aim of the study is to assess whether, after checking the anastomosis by using a water-soluble contrast enema (WCE), the closure of the ileostomy is feasible and safe, even in the presence of a persistent radiological leak. From 2003 to 2010, 210 colorectal anastomoses were performed. Ileostomy was carried out in "high-risk" anastomosis. A radiological control was performed 2 weeks later. If a leakage was present, conservative therapy controlled by serial WCEs was prescribed. Ileostomy closure was performed in the absence of leakage or with persistent leakage without clinical signs of pelvic infections. Seventy patients (33.3%) had a protective ileostomy. Fifty-eight of these (82.9%) had an uneventful course, whereas 12 (17.1%) had clinical leakage. All 70 patients were submitted to WCE after 2 weeks. Nine of 58 patients (15.5%) and eight of 12 patients with clinical anastomotic leakage showed a leakage at radiology. All these patients were scheduled another WCE 2 months later. It showed that the anastomosis had been healed in seven patients, whereas the 10 patients with leaks remained with ostomy until the third enema 1 month later. For all these patients, closure of the ileostomy was planned despite persistent radiological and subclinical leakage. A radiological study using WCE before closure of the stoma is essential and stoma closure, in the presence of a persistent leakage, is possible in selected patients.
全直肠系膜切除术后处于“高危”情况时，建议行近端转流造口术。本研究的目的是评估在使用水溶性造影剂灌肠（WCE）检查吻合口后，即使存在持续性放射学渗漏，回肠造口关闭是否可行且安全。2003年至2010年，共进行了210例结直肠吻合术。在“高危”吻合术中实施回肠造口术。2周后进行放射学检查。若存在渗漏，则采用连续WCE控制的保守治疗。在无渗漏或存在持续性渗漏但无盆腔感染临床体征的情况下进行回肠造口关闭。70例患者（33.3%）行了保护性回肠造口术。其中58例（82.9%）病程顺利，而12例（17.1%）出现临床渗漏。所有70例患者在2周后均接受了WCE检查。58例患者中有9例（15.5%），12例临床吻合口渗漏患者中有8例在放射学检查时显示有渗漏。所有这些患者在2个月后再次安排WCE检查。结果显示，7例患者的吻合口已愈合，而10例有渗漏的患者在1个月后的第三次灌肠前仍保留造口。对于所有这些患者，尽管存在持续性放射学渗漏和亚临床渗漏，仍计划关闭回肠造口。在造口关闭前使用WCE进行放射学检查至关重要，对于部分患者，即使存在持续性渗漏，也可行造口关闭。
