Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Surgery, Ersta Hospital, Stockholm, Sweden.
Colorectal Dis. 2018 Apr;20(4):304-311. doi: 10.1111/codi.13938.
Reconstruction with an ileosigmoidal anastomosis (ISA) or ileorectal anastomosis (IRA) is a surgical option after a subtotal colectomy. Anastomotic leakage (AL) is a problematic complication and high rates have been reported, but there is limited understanding of the risk factors involved. The aim of this study was to assess the established and potential predictors of AL following ISA and IRA.
This was a retrospective cohort study including all patients who had undergone ISA or IRA at three Swedish referral centres for colorectal surgery between January 2007 and March 2015. Data regarding clinical characteristics, treatment and outcome were collected from medical records. Univariate and multivariate logistic regression models were used to determine the association between patient and treatment related factors and the cumulative incidence of AL.
In total, 227 patients were included. Overall, AL was detected amongst 30 patients (13.2%). Amongst patients undergoing colectomy with synchronous ISA or IRA (one-stage procedure), AL occurred in 23 out of 120 (19.2%) compared with seven out of 107 (6.5%) after stoma reversal with ISA or IRA (two-stage procedure) (P = 0.004). In addition, the multivariate analyses revealed a statistically significantly lower odds ratio for AL following a two-stage procedure (OR 0.10, 95% CI 0.03-0.41, P = 0.001).
This study confirms high rates of AL following ISA and IRA. In particular, a synchronous procedure with colectomy and ISA/IRA carries a high risk of AL.
回肠-乙状结肠吻合术（ISA）或回肠-直肠吻合术（IRA）是次全结肠切除术后的一种手术选择。吻合口漏（AL）是一种有问题的并发症，已有报道其发生率较高，但对相关危险因素的了解有限。本研究旨在评估 ISA 和 IRA 后 AL 的既定和潜在预测因素。
这是一项回顾性队列研究，纳入了 2007 年 1 月至 2015 年 3 月期间在瑞典三个结直肠手术转诊中心接受 ISA 或 IRA 的所有患者。从病历中收集有关临床特征、治疗和结局的数据。使用单变量和多变量逻辑回归模型来确定患者和治疗相关因素与 AL 累积发生率之间的关联。
共纳入 227 例患者。总体而言，30 例（13.2%）患者检测到 AL。在接受同时进行 ISA 或 IRA 的结肠切除术（一期手术）的患者中，120 例中有 23 例（19.2%）发生 AL，而在进行 ISA 或 IRA 肠造口还纳的 107 例中（二期手术）有 7 例（6.5%）发生 AL（P=0.004）。此外，多变量分析显示，二期手术发生 AL 的比值比（OR）显著降低（OR 0.10，95%CI 0.03-0.41，P=0.001）。
本研究证实了 ISA 和 IRA 后 AL 发生率较高。特别是，结肠切除术和 ISA/IRA 的同期手术具有很高的 AL 风险。
