Department of Surgery, University of Vermont College of Medicine, Fletcher Room 301, 111 Colchester Ave, Burlington, VT 05401, USA.
JAMA Surg. 2013 Feb;148(2):177-82. doi: 10.1001/jamasurgery.2013.413.
Anastomotic leak is a potentially devastating complication of bowel surgery, yet a leak can refer to a range of clinical problems, with disparate treatment and outcomes.
To qualitatively categorize the spectrum of anastomotic leaks that occur after low anterior resection for rectal cancer and to describe their effect on outcomes.
Retrospective review of a prospective database at an academic teaching hospital.
Two hundred ten patients with at least 1 year of follow-up data.
Low anterior resection for rectal cancer.
Anastomotic leak, associated treatment, and need for permanent stoma creation.
Of 198 study patients, 168 had no demonstrated anastomotic leak, free fluid, or abscess at any time after surgery. Of the remaining 30 patients, 17 had extravasation of contrast medium into the peritoneal cavity or the presacral space on a postoperative imaging study, some long after surgery. Six to 9 of these patients seemed to meet usual clinical criteria for anastomotic leak. Ten patients had only free or simple pelvic fluid collection without extravasation of contrast medium, and 3 patients had an abscess near the anastomotic site without extravasation of contrast medium. Male sex, diabetes mellitus, and radiation therapy (but not cigarette smoking) increased the risk for anastomotic leak. Anastomotic leak was correlated with the requirement for permanent stoma creation, while only free anastomotic leak was associated with an increased incidence of irregular bowel function. Notably, simple fluid without extravasation of contrast medium also correlated with irregular bowel function.
A spectrum of clinical entities may be considered to represent an anastomotic leak after low anterior resection, with differing consequences. Presacral and free extravasation of contrast medium led to an increased need for permanent diversion, but even simple pelvic fluid collections were associated with irregular bowel function.
吻合口漏是肠外科手术的一种潜在破坏性并发症，但漏口可能指的是一系列临床表现不同的临床问题，需要不同的治疗方法和结果。
定性分类直肠癌低位前切除术后吻合口漏的范围，并描述其对结果的影响。
在学术教学医院的前瞻性数据库中进行回顾性研究。
210 例至少有 1 年随访数据的患者。
直肠癌低位前切除术。
吻合口漏、相关治疗及永久性造口的需求。
在 198 例研究患者中，168 例患者术后任何时间均无显示吻合口漏、游离液体或脓肿。其余 30 例患者中，17 例术后影像学检查显示造影剂外渗至腹膜腔或骶前间隙，其中一些发生在术后较长时间。其中 6 至 9 例患者似乎符合吻合口漏的常见临床标准。10 例患者仅出现游离或单纯盆腔积液，无造影剂外渗，3 例患者吻合口附近出现脓肿，无造影剂外渗。男性、糖尿病和放疗（而非吸烟）增加了吻合口漏的风险。吻合口漏与永久性造口的需求相关，而只有游离吻合口漏与不规则肠道功能的发生率增加相关。值得注意的是，单纯无造影剂外渗的液体也与不规则肠道功能相关。
一系列临床实体可能被认为是低位前切除术后吻合口漏的表现，其后果不同。骶前和游离造影剂外渗导致永久性引流的需求增加，但即使是单纯的盆腔积液也与不规则肠道功能相关。
