Yano Motoki, Yokoi Kohei, Numanami Hiroki, Kondo Ryoichi, Ohde Yasuhisa, Sugaya Masakazu, Narita Kunio, Chihara Koji, Matsushima Yasushi, Kobayashi Ryo, Hikosaka Yu
Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho,Mizuho-ku, Nagoya, Japan,
World J Surg. 2014 Feb;38(2):341-6. doi: 10.1007/s00268-013-2292-2.
The use of staplers for thoracic surgery has been widely accepted and regarded as a safe procedure. However, complications of stapling are occasionally experienced. The aim of this retrospective study was to analyze complications of bronchial stapling.
A retrospective multi-institutional review was conducted by the Central Japan Lung Cancer Surgery Study Group, comprising 29 institutions. All instances of bronchial stapling in thoracic surgery were reviewed during the research period.
Bronchial stapling was performed 2,030 times, using 36 kinds of staplers. The total number of complications related to stapling was 36 (1.8 %); 31 events occurred intraoperatively and five events occurred postoperatively. The intraoperative complications were air leakage (N = 20) and stapling failure (N = 11), which were caused by stapler-tissue thickness mismatch (N = 17), stapler defect (N = 3), tissue fragility (N = 2), and unknown reasons (N = 9). In all 31 cases, intraoperative complications were recovered intraoperatively with additional suturing, and no further complications were observed postoperatively. The postoperative complications were bronchopleural fistula (BPF) (N = 4) and bleeding from the chest wall (intercostal artery) (N = 1). The rate of BPF was 0.2 % (4 of 2,030). Two of four BPFs induced critical conditions. Postoperative bleeding was caused by the use of Duet TRS(TM). Both total complications and BPF occurred more frequently in the main bronchus than in the lobar or segmental bronchus. No relationship was seen between the incidence of complications and cartridge colors in lobar bronchial stapling. The compression types of staplers were associated with the incidence of complication.
Intraoperative and postoperative complications of bronchial stapling were studied. Generally, bronchial stapling in recent thoracic surgery was safe, but rare postoperative complications may induce critical conditions. Knowledge of potential complications and causes of bronchial stapling may decrease the incidence of stapling complications.
吻合器在胸外科手术中的应用已被广泛接受并被视为一种安全的手术方式。然而，吻合器使用过程中偶尔会出现并发症。本回顾性研究旨在分析支气管吻合的并发症。
日本中部肺癌外科学术研究组进行了一项回顾性多机构研究，该研究组由29个机构组成。研究期间对胸外科手术中所有支气管吻合病例进行了回顾。
共进行支气管吻合2030次，使用了36种吻合器。与吻合相关的并发症总数为36例（1.8%）；术中发生31例，术后发生5例。术中并发症为漏气（n = 20）和吻合失败（n = 11），其原因包括吻合器与组织厚度不匹配（n = 17）、吻合器缺陷（n = 3）、组织脆弱（n = 2）以及不明原因（n = 9）。在所有31例病例中，术中并发症通过额外缝合在术中得到解决，术后未观察到进一步并发症。术后并发症为支气管胸膜瘘（BPF）（n = 4）和胸壁（肋间动脉）出血（n = 1）。BPF发生率为0.2%（2030例中的4例）。4例BPF中有2例导致危急情况。术后出血是由使用Duet TRS(TM)引起的。总并发症和BPF在主支气管中的发生率均高于叶支气管或段支气管。叶支气管吻合中并发症发生率与钉仓颜色之间无关联。吻合器的加压类型与并发症发生率相关。
对支气管吻合的术中及术后并发症进行了研究。总体而言，近期胸外科手术中的支气管吻合是安全的，但罕见的术后并发症可能导致危急情况。了解支气管吻合潜在并发症及原因可能会降低吻合并发症的发生率。
