Iwamoto Masayoshi, Kawada Kenji, Hida Koya, Hasegawa Suguru, Sakai Yoshiharu
Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Surgery, National Hospital Organization Himeji Medical Center, Himeji, Japan.
World J Surg Oncol. 2017 Aug 1;15(1):143. doi: 10.1186/s12957-017-1208-2.
Anastomotic leakage (AL) is one of the most dreadful postoperative complications because it can result in increased morbidity and mortality as well as poorer long-term prognosis. Although most studies of AL limited their investigation time to a period of 30 days postoperatively, only a few studies have shown that AL can occur after that period. Here, we report four patients of rectal cancer with delayed AL following laparoscopic intersphincteric resection (ISR) and conduct a literature review on delayed AL.
Case 1 was a 67-year-old male who underwent laparoscopic partial ISR in July 2009. Although the patient was asymptomatic, an anastomotic-urethral fistula was observed 57 months after ISR. Case 2 was a 44-year-old female who underwent laparoscopic partial ISR in July 2008. She presented with discharge of gas and feces from her vagina, and an anastomotic-vaginal fistula was observed 14 months after ISR. Case 3 was a 74-year-old man who underwent laparoscopic partial ISR in August 2007. He presented with pneumaturia and fecaluria, and an anastomotic-urethral fistula was observed 4 months after ISR. Case 4 was a 68-year-old woman who underwent laparoscopic subtotal ISR for rectal cancer in February 2013 and partial hepatic resection for liver metastases in March 2013. She presented with anal pain and purulent perineal discharge, and an anastomotic-perineal fistula was observed 9 months after ISR. All four cases presented with fistula formation and required reoperation (establishment of a diverting ileostomy).
Since delayed AL is not a rare postoperative complication, surgeons need to provide long-term follow-up and remain alert to the possible development of delayed AL.
吻合口漏（AL）是最可怕的术后并发症之一，因为它会导致发病率和死亡率增加，以及长期预后较差。尽管大多数关于AL的研究将调查时间限制在术后30天内，但只有少数研究表明AL可在该时间段后发生。在此，我们报告4例腹腔镜括约肌间切除术（ISR）后发生延迟性AL的直肠癌患者，并对延迟性AL进行文献综述。
病例1为一名67岁男性，于2009年7月接受腹腔镜部分ISR。尽管患者无症状，但在ISR后57个月观察到吻合口尿道瘘。病例2为一名44岁女性，于2008年7月接受腹腔镜部分ISR。她出现阴道排气和排便，在ISR后14个月观察到吻合口阴道瘘。病例3为一名74岁男性，于2007年8月接受腹腔镜部分ISR。他出现气尿和粪尿，在ISR后4个月观察到吻合口尿道瘘。病例4为一名68岁女性，于2013年2月因直肠癌接受腹腔镜次全ISR，并于2013年3月因肝转移接受部分肝切除术。她出现肛门疼痛和会阴部脓性分泌物，在ISR后9个月观察到吻合口会阴瘘。所有4例均出现瘘形成，需要再次手术（建立转流性回肠造口术）。
由于延迟性AL并非罕见的术后并发症，外科医生需要进行长期随访，并对延迟性AL的可能发生保持警惕。
