Department of Surgery and Transplantation, Chaim Sheba Medical Center, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
Tech Coloproctol. 2012 Jun;16(3):187-99. doi: 10.1007/s10151-012-0825-6. Epub 2012 Apr 26.
The main serious risks of anastomotic construction in the colon and rectum include dehiscence and stricture formation. There is a resurgence of interest in sutureless anastomoses formed by compression elements since the introduction of shape memory alloy (SMA) systems, which evoke minimal early inflammatory response whilst maintaining anastomotic integrity. Currently, the most commonly used SMA is the nickel-titanium (NiTi) alloy that is highly biocompatible, returning to its pre-deformed stable (austenite) shape under different mechanical and thermal loads for use in humans. Pre-clinical data for shape memory alloy systems in colorectal anastomoses are limited, but it appears to be safe in porcine and canine models with limited leakage and reduced stricture formation. There does not appear to be any difference in tissue biochemistry of inflammatory markers when compared with conventional stapled techniques, although the few studies available show a markedly reduced early inflammatory response at the anastomotic site with the NiTi device. The majority of the clinical data concerning compression anastomoses are derived from the biofragmentable anastomotic ring device. This device has fallen out of use because of reported leaks, instrumental failure and problems with device expulsion. A novel SMA device, the NiTi anastomotic ring, permits construction of a low rectal anastomosis construction during open or laparoscopic procedures. The preliminary data demonstrate a safety comparable to conventional staple technology. This device also provides the potential of benefit of reduced anastomotic inflammation, because the compression ring results in direct serosa-to-serosa (or alternatively serosa-to-muscularis propria) apposition without the persistence of residual foreign material. This type of construction could lead to a reduced incidence of early anastomotic leakage and/or the development of anastomotic stenosis. Randomized clinical trials employing a NiTi arm for elective, emergency and high-risk colorectal anastomoses are required to determine its indications and clinical profile as well as to assess whether such technology may selectively obviate the need for proximal diversion in low colorectal anastomoses.
结直肠吻合术的主要严重风险包括吻合口裂开和狭窄形成。自形状记忆合金（SMA）系统问世以来，人们对无缝合吻合术产生了浓厚的兴趣，因为这种吻合术引发的早期炎症反应最小，同时保持吻合口的完整性。目前，最常用的 SMA 是镍钛（NiTi）合金，它具有高度的生物相容性，在人体中受到不同的机械和热负荷时会恢复到其预先变形的稳定（奥氏体）形状。SMA 系统在结直肠吻合术中的临床前数据有限，但在猪和犬模型中似乎是安全的，吻合口漏出和狭窄形成减少。与传统吻合钉技术相比，炎症标志物的组织生化似乎没有差异，尽管现有研究表明，NiTi 器械在吻合部位的早期炎症反应明显降低。大多数关于压缩吻合术的临床数据来自可生物降解吻合环装置。由于报道的漏液、器械故障和器械排出问题，该装置已不再使用。一种新型的 SMA 装置，NiTi 吻合环，允许在开放或腹腔镜手术中构建低位直肠吻合术。初步数据表明，其安全性可与传统吻合钉技术相媲美。该装置还具有减少吻合口炎症的潜在益处，因为压缩环导致直接浆膜对浆膜（或替代浆膜对固有肌层）贴合，而没有残留异物的存在。这种类型的构建可能会降低早期吻合口漏的发生率和/或吻合口狭窄的发展。需要进行随机临床试验，使用 NiTi 臂进行择期、紧急和高危结直肠吻合术，以确定其适应证和临床特征，并评估这种技术是否可以选择性地避免低位结直肠吻合术近端分流的需要。
