Luchtefeld M A, Milsom J W, Senagore A, Surrell J A, Mazier W P
Department of Surgical Research, Ferguson Clinic, Grand Rapids, Michigan 49503.
Dis Colon Rectum. 1989 Sep;32(9):733-6. doi: 10.1007/BF02562119.
Anastomotic stenosis is a poorly understood and underexamined complication of gastrointestinal surgery, reportedly most frequent in the coloproctostomy. In order to better define this problem, a questionnaire was sent to members of the American Society of Colon and Rectal Surgeons regarding patients with gastrointestinal anastomotic stenosis. A total of 123 patients with intestinal anastomotic stenosis were analyzed. Eighty-two anastomoses were stapled and 41 were handsewn. Nearly all stenoses occurred in the distal bowel (70 rectal, 23 sigmoid colon). Preoperative risk factors identified were obesity (28 patients) and abscess (12 patients). Incomplete "doughnuts" were noted in 12 patients. Postoperative anastomotic leaks (15 patients), pelvic infection (13 patients), and postoperative radiation (7 patients) were believed to be contributing factors. Dilatation, using a variety of techniques, was the sole treatment for 65 patients, however, intra-abdominal surgery was necessary in 34 patients. Large intestinal anastomotic stenosis probably occurs most commonly following coloproctostomy (both with handsewn and stapled anastomoses). Dilatation alone resulted in adequate treatment in most patients in the study. Major surgery was required to correct this problem in a significant number of patients (28 percent) in this series. The true incidence of anastomotic stenosis in colorectal surgery is unknown and warrants further study.
吻合口狭窄是一种在胃肠外科手术中尚未被充分理解和研究不足的并发症，据报道在结肠直肠吻合术中最为常见。为了更好地界定这一问题，我们向美国结肠和直肠外科医师协会的成员发送了一份关于胃肠吻合口狭窄患者的调查问卷。总共分析了123例肠吻合口狭窄患者。其中82例吻合采用吻合器，41例采用手工缝合。几乎所有狭窄都发生在远端肠管（70例在直肠，23例在乙状结肠）。确定的术前危险因素为肥胖（28例患者）和脓肿（12例患者）。12例患者出现“荷包”不完全。术后吻合口漏（15例患者）、盆腔感染（13例患者）和术后放疗（7例患者）被认为是促成因素。采用多种技术进行扩张是65例患者的唯一治疗方法，然而，34例患者需要进行腹腔内手术。大肠吻合口狭窄可能最常发生在结肠直肠吻合术后（包括手工缝合和吻合器吻合）。在本研究中，单纯扩张对大多数患者产生了充分的治疗效果。在本系列的相当一部分患者（28%）中，需要进行大手术来纠正这一问题。结直肠手术中吻合口狭窄的真实发生率尚不清楚，值得进一步研究。
