Kotoč J, Kotočová K, Gatěk J, Vrzgula A, Pribula V, Hladík M, Olejník J
Rozhl Chir. 2014 Dec;93(12):578-82.
Anastomotic insufficiency (anastomotic leakage) is one of the most serious complications of the sphincter-saving rectal resections, with significant impact on patient morbidity and mortality. The risk rate of anastomotic leakage may be influenced by local anatomic conditions - tumour localisation and stage, possible technical problems in anastomosis construction (ischaemia, anastomosis under tension), and by complex factors associated with the patient - malnutrition, obesity, smoking, corticosteroid therapy and preoperative chemoradiation.
All sphincter-saving rectal resections that were performed between September 2011 and April 2014 in three centres of colorectal surgery, i.e. at Atlas Hospital in Zlín, the Czech Republic, and at Košice-Šaca Hospital and Dérers University Hospital in Bratislava, Slovakia, were included in the present multicentric prospective study. The incidence of anastomotic leakage in laparoscopic and open surgery was compared and the risk factors resulting in leakage occurrence were analyzed.
Anastomotic leakage developed in 12 (10.9%) out of the total number of 110 patients. In the laparoscopic group (58 patients), the insufficiency occurred 4x (6.9%), in the 17 converted patients 3x (17.6%), and in the open surgery group (35 patients) the leakage occurred 5x (14.3%). There was no statistically significant difference between these groups. Nevertheless, patients with anastomotic leakage were only males (P=0.006), they had significantly lower pre-operative albumin levels (35.8 g/l vs. 38.3 g/l; P=0.03), as well as a lower pre-operative total protein level (60.8 g/l vs. 64.1 g/l; P=0.07), when compared to patients without insufficiency. Tumour distance from the anal verge in patients with anastomotic leakage was also significantly lower (10.8 cm vs. 12.8 cm; P=0.05).
The following risk factors for anastomotic insufficiency after rectal surgery were identified: male gender, low pre-operative albumin and total protein levels, as well as decreasing tumour distance from the anal verge. The difference in the incidence of anastomotic insufficiency between laparoscopic and open surgery groups was not statistically significant.
吻合口功能不全（吻合口漏）是保留括约肌直肠切除术最严重的并发症之一，对患者的发病率和死亡率有重大影响。吻合口漏的风险率可能受局部解剖条件影响——肿瘤定位和分期、吻合口构建中可能存在的技术问题（缺血、吻合口张力），以及与患者相关的复杂因素——营养不良、肥胖、吸烟、皮质类固醇治疗和术前放化疗。
本多中心前瞻性研究纳入了2011年9月至2014年4月在三个结直肠外科中心进行的所有保留括约肌直肠切除术，即在捷克共和国兹林的阿特拉斯医院、斯洛伐克布拉迪斯拉发的科希策-沙察医院和德雷斯大学医院。比较了腹腔镜手术和开放手术中吻合口漏的发生率，并分析了导致漏发生的危险因素。
110例患者中，12例（10.9%）发生吻合口漏。在腹腔镜组（58例患者）中，功能不全发生4例（6.9%），17例中转患者中发生3例（17.6%），开放手术组（35例患者）中发生5例（14.3%）。这些组之间无统计学显著差异。然而，与无功能不全的患者相比，发生吻合口漏患者仅为男性（P = 0.006），术前白蛋白水平显著更低（35.8 g/l对38.3 g/l；P = 0.03），术前总蛋白水平也更低（60.8 g/l对64.1 g/l；P = 0.07）。发生吻合口漏患者的肿瘤距肛缘距离也显著更低（10.8 cm对12.8 cm；P = 0.05）。
确定了直肠手术后吻合口功能不全的以下危险因素：男性、术前白蛋白和总蛋白水平低，以及肿瘤距肛缘距离减小。腹腔镜手术组和开放手术组吻合口功能不全发生率的差异无统计学显著性。
