Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Sci Rep. 2017 Jan 13;7:39936. doi: 10.1038/srep39936.
Early anastomotic leakage (AL), usually defined as leakage within 30 post-operative days, represents a severe entity. However, mounting evidence has indicated that majorities of leakage occur within one week after surgery, making late AL rarity. Here we analyzed 101 consecutive colorectal AL, all of which occurred within 30 post-operative days, during Jan 2013 and Dec 2015 in cancer hospital of Fudan University. AL occurring within 5 post-operative days was defined as very early AL (vE-AL). We evaluated risk factors of vE-AL compared with non-vEAL and correlated with post-leakage peritonitis and need of relaparatomy. We found that AL occurred at median time of 7 days after surgery. 23 cases were vE-AL. Reconstruction of post-peritoneum for mid-low rectal carcinoma significantly reduced incidence of vE-AL compared with non-vE-AL (p = 0.042). Patients with vE-AL was associated with presence of peritonitis (p = 0.031), the latter significantly correlated with increased re-operation rate (p = 6.8E-13). Besides, patients with vE-AL trended to correlate with increased re-operation rate after leakage (p = 0.088). In concludsion, vE-AL occurring within 5 post-operative days represents a severe subtype associated with general peritonitis and need of relaparatomy.
早期吻合口漏（AL）通常定义为术后 30 天内发生的漏，是一种严重的并发症。然而，越来越多的证据表明，大多数漏发生在手术后一周内，因此晚期 AL 较为罕见。在这里，我们分析了 2013 年 1 月至 2015 年 12 月在复旦大学附属肿瘤医院连续收治的 101 例结直肠 AL，均发生在术后 30 天内。术后 5 天内发生的 AL 定义为非常早期 AL（vE-AL）。我们评估了 vE-AL 与非 vE-AL 的危险因素，并与术后腹膜炎和再次剖腹手术的需要相关联。我们发现 AL 发生在术后中位时间为 7 天。23 例为 vE-AL。中低位直肠肿瘤腹膜后重建显著降低了 vE-AL 的发生率（p=0.042）。vE-AL 患者与腹膜炎的存在有关（p=0.031），后者与再手术率的增加显著相关（p=6.8E-13）。此外，vE-AL 患者在漏发生后再手术率有增加的趋势（p=0.088）。总之，术后 5 天内发生的 vE-AL 是一种与全身性腹膜炎和再次剖腹手术相关的严重亚型。
