Kingsnorth A N, Makin C A, Ellenbogen S
J R Coll Surg Edinb. 1989 Jun;34(3):130-2.
Seventy gastrointestinal anastomoses were constructed in 52 patients using a single layer of interrupted sutures placed in the serosubmucosal or extramucosal layer. Gastric anastomoses (n = 16) were performed by a partly open method, small bowel and colonic anastomoses (n = 44) by a closed method, and colorectal anastomoses (n = 10) by an open method. Wound infection occurred in two patients (3.8%) and three patients died (5.8%). Anastomotic leakage in four patients (7.7%) arose from three ileocolic anastomoses and one colorectal anastomosis. The third leak from an ileocolic anastomosis resulted in death and necessitated termination of the study on ethical grounds. There were two other postoperative deaths from cardiorespiratory causes (3.8%). The serosubmucosal or extramucosal technique is safe and effective (leak rate 1 of 26; 3.8%) when performed by the partly open or open method for gastric and colorectal anastomoses. However, when constructed by the closed method a relatively high leakage rate (3 of 44; 6.8%) occurs in anastomoses (ileocolic) generally associated with a low morbidity.
52例患者共进行了70次胃肠吻合术，采用单层间断缝合，缝合于浆膜下层或黏膜外层。胃吻合术（n = 16）采用部分开放法，小肠和结肠吻合术（n = 44）采用闭合法，结直肠吻合术（n = 10）采用开放法。2例患者发生伤口感染（3.8%），3例患者死亡（5.8%）。4例患者（7.7%）发生吻合口漏，其中3例为回结肠吻合口漏，1例为结直肠吻合口漏。1例回结肠吻合口第三次发生漏导致患者死亡，基于伦理原因研究被迫终止。另外有2例患者因心肺原因术后死亡（3.8%）。对于胃和结直肠吻合术，采用部分开放或开放法进行浆膜下层或黏膜外层技术是安全有效的（漏率为26例中的1例；3.8%）。然而，采用闭合法进行吻合术（回结肠）时，通常发病率较低，但漏率相对较高（44例中的3例；6.8%）。
