Teixeira Farinha Hugo, Melloul Emmanuel, Hahnloser Dieter, Demartines Nicolas, Hübner Martin
Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, 1011 Switzerland.
World J Emerg Surg. 2016 May 4;11:19. doi: 10.1186/s13017-016-0073-6. eCollection 2016.
Primary anastomosis is considered the standard strategy after right emergency colectomy. The present study aimed to evaluate alternative treatment strategies when primary anastomosis is not possible to prevent definitive ostomy.
This retrospective study included all consecutive patients who underwent right emergency colectomy between July 2006 and June 2013. Demographics, surgical data, and postoperative outcomes were entered in an anonymized database. Comparative analysis was performed between patients with primary anastomosis (PA group) and those where alternative strategies were employed (no-PA group). Outcomes were 30 days complications rate and rate of bowel continuity restoration.
One hundred forty-eight patients (57 % male) with a median age of 65 years (15-96) were included. One hundred and sixteen patients underwent PA (78 %) and 32 were in the no-PA group (22 %). No-PA group patients had more comorbidities (Carlson comorbidity index >3: 98 % vs. 54, p < 0.001). Major complications rate (Dindo-Clavien III to IV) was 24 % in PA group, 88 % in no-PA group (p < 0.001). The 30-day mortality rate was 6 % (n = 7) in PA group versus 25 % (n = 8) in no-PA group (p = 0.004). Fourteen patients in the no-PA group had a split stoma and 18 had a two-staged procedure. Five patients had continuity restoration after initial split stoma (36 %) compared to 10 after a two-staged procedure (55 %; p = 0.265). Anastomotic leak occurred in 10 patients of the PA group (9 %) versus 0 in the no-PA group, where 15 out of 32 patients (47 %) had continuity restoration.
Eighty percent of patients requiring emergency right colectomy were anastomosed primarily. For the remaining a two-staged procedure might facilitate bowel continuity restoration in the long-term.
一期吻合术被认为是急诊右半结肠切除术后的标准策略。本研究旨在评估在无法进行一期吻合术以避免永久性造口时的替代治疗策略。
这项回顾性研究纳入了2006年7月至2013年6月期间所有连续接受急诊右半结肠切除术的患者。人口统计学资料、手术数据和术后结果被录入一个匿名数据库。对接受一期吻合术的患者（PA组）和采用替代策略的患者（非PA组）进行了比较分析。观察指标为30天并发症发生率和肠道连续性恢复率。
共纳入148例患者（57%为男性），中位年龄65岁（15 - 96岁）。116例患者接受了一期吻合术（78%），32例在非PA组（22%）。非PA组患者合并症更多（卡尔森合并症指数>3：98%对54%，p < 0.001）。PA组严重并发症发生率（Dindo-Clavien III至IV级）为24%，非PA组为88%（p < 0.001）。PA组30天死亡率为6%（n = 7），非PA组为25%（n = 8）（p = 0.004）。非PA组14例患者行分期造口，18例患者接受两阶段手术。5例患者在初始分期造口后恢复了肠道连续性（36%），两阶段手术后为10例（55%；p = 0.265）。PA组10例患者发生吻合口漏（9%），非PA组为0，非PA组32例患者中有15例（47%）恢复了肠道连续性。
80%需要急诊右半结肠切除术的患者接受了一期吻合术。对于其余患者，两阶段手术可能有助于长期恢复肠道连续性。
