Center for Integration of Advanced Medicine, Kyushu University, Fukuoka, Japan.
Center for Integration of Advanced Medicine, Kyushu University, Fukuoka, Japan.
J Surg Res. 2015 Jan;193(1):126-34. doi: 10.1016/j.jss.2014.07.009. Epub 2014 Jul 9.
Anastomotic leakage (AL) is a major complication after anterior resection. However, its therapeutic strategies and technical risk factors have not been well established. Therefore, we endoscopically evaluated anastomotic regions after laparoscopic colorectal anastomosis using a double-stapling technique (DST) for determination of treatment and investigation of technical factors.
In total, 191 consecutive patients underwent laparoscopic anterior resection with a DST from September 2008-January 2013. Anastomotic regions were endoscopically evaluated in patients suspected to have AL after surgery.
Anastomotic dehiscence was observed in 19 patients, and AL was diagnosed in 18 (9.3%). Of the 19 patients, 12 were treated by creation of an intestinal stoma and 7 were treated conservatively based on their clinical status and endoscopic findings. Twenty-three dehiscences were observed among 19 anastomotic regions; all 23 were observed on the circular stapler anastomosis lines. Of these 23 dehiscences, 13 (56.5%) were located at the point at which the anastomosis lines of the circular and linear staplers overlapped, and 10 (43.5%) were located on the circumferential aspect between the overlapping points.
Endoscopic evaluation of anastomotic regions is safe and useful for the determination of therapeutic strategies. The DST anastomotic technique itself may be closely related to the development of AL.
吻合口漏（AL）是前切除术的主要并发症。然而，其治疗策略和技术危险因素尚未得到很好的确定。因此，我们使用双吻合器技术（DST）对腹腔镜结直肠吻合术后的吻合部位进行内镜评估，以确定治疗方法并研究技术因素。
2008 年 9 月至 2013 年 1 月，共对 191 例连续接受腹腔镜前切除术和 DST 的患者进行了研究。术后怀疑有 AL 的患者对吻合部位进行了内镜评估。
19 例患者出现吻合口裂开，18 例（9.3%）诊断为 AL。在这 19 例患者中，12 例行肠造口术治疗，7 例根据其临床状况和内镜检查结果行保守治疗。在 19 个吻合部位中观察到 23 个吻合口裂开；所有 23 个均发生在圆形吻合器吻合线上。在这 23 个吻合口裂开中，13 个（56.5%）位于圆形吻合器和线性吻合器吻合线重叠处，10 个（43.5%）位于重叠点之间的环形部位。
吻合部位的内镜评估是安全且有用的，可用于确定治疗策略。DST 吻合技术本身可能与 AL 的发生密切相关。
