Numata Masakatsu, Yamaguchi Tomohiro, Kinugasa Yusuke, Shiomi Akio, Kagawa Hiroyasu, Yamakawa Yushi, Furuatni Akinobu, Manabe Shoichi, Yamaoka Yusuke, Torii Kakeru, Kato Shunichiro
Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
Asian J Endosc Surg. 2018 Aug;11(3):227-232. doi: 10.1111/ases.12452. Epub 2018 Jan 11.
The safety and feasibility of laparoscopic reoperation for anastomotic leakage remain unclear.
A total of 3321 patients underwent laparoscopic surgery for primary colorectal cancer at a tertiary referral center from September 2002 to May 2016. Of these, 31 patients who underwent reoperation for treatment of anastomotic leakage were enrolled in this study and divided into two reoperation groups: laparoscopic (n = 15) and open (n = 16). Data regarding patient demographics, operative outcomes, morbidity, length of hospital stay, mortality, and stoma closure after reoperation in the two groups were compared.
No significant difference was observed in the primary surgery procedure between the two groups. Estimated blood loss (1 vs 9 mL, P = 0.020), total postoperative complications (26.7% vs 68.8%, P = 0.032), wound infection (0.0% vs 31.2%, P = 0.043), and postoperative hospital stay (18 vs 31 days, P = 0.017) were significantly better in the laparoscopic group than in the open group. Although the rate of stoma closure after reoperation was higher in the laparoscopic group, the difference was not significant (86.7% vs 62.5%, P = 0.220).
Laparoscopic reoperation exhibited better short-term outcomes than open reoperation for selected patients with anastomotic leakage.
腹腔镜再次手术治疗吻合口漏的安全性和可行性尚不清楚。
2002年9月至2016年5月，共有3321例患者在一家三级转诊中心接受了腹腔镜原发性结直肠癌手术。其中，31例因吻合口漏接受再次手术的患者被纳入本研究，并分为两个再次手术组：腹腔镜组（n = 15）和开放组（n = 16）。比较两组患者的人口统计学数据、手术结果、发病率、住院时间、死亡率以及再次手术后造口关闭情况。
两组初次手术方式无显著差异。腹腔镜组的估计失血量（1 vs 9 mL，P = 0.020）、术后总并发症发生率（26.7% vs 68.8%，P = 0.032）、伤口感染率（0.0% vs 31.2%，P = 0.043）和术后住院时间（18 vs 31天，P = 0.017）均显著优于开放组。虽然腹腔镜组再次手术后造口关闭率较高，但差异无统计学意义（86.7% vs 62.5%，P = 0.220）。
对于选定的吻合口漏患者，腹腔镜再次手术的短期效果优于开放再次手术。
