Sasaki Kazuhito, Ishihara Soichiro, Nozawa Hiroaki, Kawai Kazushige, Hata Keisuke, Kiyomatsu Tomomichi, Tanaka Toshiaki, Nishikawa Takeshi, Otani Kensuke, Yasuda Koji, Murono Koji, Watanabe Toshiaki
Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
Dig Surg. 2018;35(3):266-270. doi: 10.1159/000480157. Epub 2017 Sep 22.
BACKGROUND/AIMS: Anastomotic leakage remains the most serious complications of colorectal surgery. To prevent colorectal anastomotic leakage (CAL), an air leak test (ALT) with intraoperative colonoscopy (IOCS) is performed to detect mechanically insufficient colorectal anastomoses. The approaches to an intraoperative anastomotic air leak (IOAL) have not been fully investigated. This study aimed to clarify the safe management of an IOAL in laparoscopic colorectal surgery.
One hundred forty-eight consecutive patients who underwent laparoscopic resection with double-stapling technique (DST) anastomosis for left-sided colorectal cancer between April 2015 and June 2016 were included and retrospectively reviewed.
Intraoperative anastomotic ALT yielded positive results in 7 patients. In all 7 patients, reanastomoses were performed, and diverting stomas were constructed to protect the anastomosis in 2 patients whose reanastomosis sites were close to the anus. Three of the revised DST anastomoses showed air leakage on the repeat ALT; these sites underwent suturing repair and were confirmed to be airtight. None of the patients with a positive intraoperative ALT had postoperative CAL. The overall CAL rate was 1.4%.
Combination management using DST revision, direct suturing repair, and a diverting stoma is recommended for intraoperative repair of anastomotic defects detected by IOCS.
背景/目的：吻合口漏仍是结直肠手术最严重的并发症。为预防结直肠吻合口漏（CAL），采用术中结肠镜检查（IOCS）进行漏气试验（ALT）以检测机械性不足的结直肠吻合口。术中吻合口漏气（IOAL）的处理方法尚未得到充分研究。本研究旨在阐明腹腔镜结直肠手术中IOAL的安全管理方法。
纳入2015年4月至2016年6月期间连续148例行腹腔镜下左侧结直肠癌双吻合器技术（DST）吻合切除术的患者，并进行回顾性分析。
术中吻合口ALT检查有7例结果为阳性。所有7例患者均进行了再次吻合，其中2例再次吻合部位靠近肛门的患者行转流造口以保护吻合口。3例经修订的DST吻合口在重复ALT检查时出现漏气；这些部位进行了缝合修复，证实不漏气。术中ALT阳性的患者均未发生术后CAL。总体CAL发生率为1.4%。
对于IOCS检测到的吻合口缺陷，建议采用DST修订、直接缝合修复和转流造口相结合的方法进行术中修复。
