Cimitan Andrea, Contardo Tania, Molaro Roberta, Morpurgo Emilio
Department of Surgery, Regional Center for Laparoscopic and Robotic Surgery, Camposampiero Hospital, Padua, Italy.
Surg Laparosc Endosc Percutan Tech. 2016 Aug;26(4):e80-4. doi: 10.1097/SLE.0000000000000301.
The aim of this study was to describe the role of laparoscopy in the treatment of leaks occurring after minimally invasive colorectal resections.
Thirty-four of 566 consecutive patients who underwent minimally invasive colorectal resection for cancer between January 2004 and December 2012 and who showed signs of anastomotic leakage (6%) requiring reoperation were studied using a prospectively maintained database. Patient characteristics, clinical signs, the surgical approach, the role of laparoscopy, operative and postoperative results, and the rate of permanent stoma were analyzed.
The median time to diagnosis of an anastomotic leak after surgery was 5.5 days. The median time to reoperation from the diagnosis of leakage was 2 days. Leaks were treated laparoscopically in 21 of 34 (61.8%) patients. Anastomoses were dismantled in 14 patients (41.2%) and the procedure was performed laparoscopically in 28.6% of the cases. The postoperative morbidity was 55.9%, the perioperative mortality 5.7%, and the rate of permanent stoma was 8.8%.
Laparoscopic reoperation can be performed in most cases of anastomotic leaks occurring after minimally invasive colorectal resection for cancer. Anastomosis can be dismantled laparoscopically in 28.6% of the cases. A permanent stoma was necessary only in patients with terminal stomas.
本研究旨在描述腹腔镜检查在微创结直肠癌切除术后发生渗漏治疗中的作用。
利用前瞻性维护的数据库，对2004年1月至2012年12月期间连续566例行微创结直肠癌切除术且出现吻合口漏迹象（6%）需要再次手术的患者中的34例进行研究。分析患者特征、临床体征、手术方式、腹腔镜检查的作用、手术及术后结果以及永久性造口率。
术后诊断吻合口漏的中位时间为5.5天。从诊断漏出到再次手术的中位时间为2天。34例患者中有21例（61.8%）通过腹腔镜治疗漏出。14例患者（41.2%）拆除吻合口，其中28.6%的病例通过腹腔镜进行该操作。术后发病率为55.9%，围手术期死亡率为5.7%，永久性造口率为8.8%。
对于微创结直肠癌切除术后发生的大多数吻合口漏病例，可进行腹腔镜再次手术。28.6%的病例可通过腹腔镜拆除吻合口。仅终末造口患者需要永久性造口。
