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胃肠手术中的吻合口漏及其预防

Anastomotic leaks in gastrointestinal surgery and their prevention.

作者信息

Banasiewicz Tomasz, Dziki Adam, Lampe Paweł, Lorenc Zbigniew, Szczepkowski Marek, Zieliński Jacek, Wallner Grzegorz

机构信息

Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej Uniwersytetu Medycznego im. K. Marcinkowskiego w Poznaniu.

Klinika Chirurgii Ogólnej i Kolorektalnej UM w Łodzi.

出版信息

Pol Przegl Chir. 2017 Apr 30;89(2):49-56. doi: 10.5604/01.3001.0009.8979.

Abstract

Anastomotic leak in the gastrointestinal tract is one of the most important complications of resection. They are the main cause of reoperation, their occurrence worsens the prognosis of the patient, increasing the proportion of direct mortality, as well as being a significant risk factor for recurrence of cancer. The risk of leaks within the gastrointestinal tract is greatly varied, depending on the location and extent of the resection, but also on patient, disease or a surgical procedure, including surgeon. To determine the potential risk of leakage can be significant for introduction some prophylactic actions. Some of them have the character of general recommendations, as proper nutrition of the patient in the perioperative period, while another part is directly connected to the surgical procedure. The second group includes protective stoma, the use of tissue glues, insertion transrectal drain for rectal anastomosis decompression, the use of stents or the use of collagen matrix coated with fibrinogen and thrombin. Important to reduce the proportion of leaks can be more precise and targeted prophylactic recommendations, based on the individualized determination of risk factors leaks. Further research for this purpose are necessary for this purpose, the big hope can be associated with data obtained through mobile applications.

摘要

胃肠道吻合口漏是切除术最重要的并发症之一。它们是再次手术的主要原因,其发生会恶化患者的预后,增加直接死亡率,同时也是癌症复发的重要危险因素。胃肠道内漏的风险差异很大,取决于切除的部位和范围,也取决于患者、疾病或手术操作,包括外科医生。确定潜在的漏出风险对于采取一些预防性措施可能具有重要意义。其中一些具有一般建议的性质,如患者围手术期的适当营养,而另一部分则与手术操作直接相关。第二组措施包括保护性造口、使用组织胶水、插入经直肠引流管以减轻直肠吻合口压力、使用支架或使用涂有纤维蛋白原和凝血酶的胶原基质。基于对漏出风险因素的个体化确定,更精确和有针对性的预防性建议对于降低漏出比例可能很重要。为此目的进行进一步研究是必要的,很大的希望可能与通过移动应用程序获得的数据相关。

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