Tao Kaixiong, Gao Jinbo
Department of Gastrointestinal surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technologe, Wuhan 430022, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2018;21(4):384-387.
Anastomotic leakage is one of the common complications after rectal cancer surgery. Advances in the field of rectal surgery, such as introduction of total mesorectal excision, double-stapling reconstruction techniques, and minimally invasive surgery have improved oncologic outcomes and resulted in more favorable functional results, with a greater proportion of patients undergoing sphincter-preserving surgeries. Despite technical improvements, the incidence of anastomotic leakage has not decreased significantly. The incidence of anastomotic leakage is related to many factors, including patient-related factors, such as male sex, obesity, low score of nutrition risk screening, and III(-IIIII( grade of ASA grading; disease-related factors, such as lower tumor location, tumor diameter >3 cm, preoperative chemoradiotherapy and comorbidity; surgery-related factors, such as open or laparoscopic surgery, blood supply of anastomosis, tension of anastomosis, preventive stoma, duration of surgery, intraoperative blood loss, intraoperative events, and contamination, as well as selection and use of anastomotic device. Fully understanding the risk factors of anastomotic leakage are very important for reducing the occurrence of anastomotic leakage. For patients with risk factors, appropriate preventive measures should be implemented timely to reduce the risk of anastomotic leakage.
吻合口漏是直肠癌手术后常见的并发症之一。直肠手术领域的进展,如全直肠系膜切除术的引入、双吻合器重建技术和微创手术,改善了肿瘤学结局并带来了更良好的功能结果,更多患者接受了保肛手术。尽管技术有所改进,但吻合口漏的发生率并未显著降低。吻合口漏的发生率与许多因素有关,包括患者相关因素,如男性、肥胖、营养风险筛查评分低和美国麻醉医师协会(ASA)分级III(-IIIII(级;疾病相关因素,如肿瘤位置较低、肿瘤直径>3 cm、术前放化疗和合并症;手术相关因素,如开放或腹腔镜手术、吻合口血供、吻合口张力、预防性造口、手术持续时间、术中失血、术中事件和污染,以及吻合器的选择和使用。充分了解吻合口漏的危险因素对于减少吻合口漏的发生非常重要。对于有危险因素的患者,应及时采取适当的预防措施以降低吻合口漏的风险。