Barugola Giuliano, Bertocchi Elisa, Gentile Irene, Cracco Nicola, Sartori Carlo Augusto, Ruffo Giacomo
Department of General Surgery, Sacred Heart - Don Calabria Hospital, Via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy.
Updates Surg. 2018 Dec;70(4):459-465. doi: 10.1007/s13304-018-0555-z. Epub 2018 Jun 27.
The aim was to report our experience with delayed colo-anal anastomosis (DCA) to avoid permanent stoma for complex rectal cases evaluating short- and long-term outcomes. Nine patients who underwent DCA from 2011 to 2016 were collected and analysed case by case. We considered medical history and surgical outcomes. Long-term bowel function was evaluated using the Wexner and low anterior resection syndrome (LARS) score at 6, 12 and 24 months. The range from previous surgery and salvage procedure was 337 days. All cases were performed with a full laparoscopic approach. The median length of hospital stay was 15 days. The median follow-up was 970.5 days. There was no peri-operative mortality. Two patients developed a post-operative pelvic abscess that required redo surgery. Long-term post-operative complications were mucosal prolapsed, anastomosis retraction and anastomotic stricture. The average values of LARS and Wexner scores were, respectively, at 6 months 33.7 and 16.2, at 12 months 28.5 and 11.7, at 24 months 21.1 and 6.7. Colo-anal sleeve delayed anastomosis appears a real answer to avoid permanent stoma in selected patients. The laparoscopic procedure is safe and feasible for skilful mini-invasive surgeons. Our experience describes the complexity of clinical history of these patients underlying a slow, but progressive improvement in continence after restoration of bowel continuity.
本研究旨在报告我们在复杂直肠病例中采用延迟结肠肛管吻合术（DCA）以避免永久性造口的经验，并评估其短期和长期疗效。收集了2011年至2016年期间接受DCA的9例患者，并逐例进行分析。我们考虑了病史和手术结果。使用Wexner评分和低位前切除综合征（LARS）评分在术后6、12和24个月评估长期肠道功能。上次手术至挽救手术的间隔时间为337天。所有病例均采用全腹腔镜手术方式。中位住院时间为15天。中位随访时间为970.5天。无围手术期死亡病例。2例患者发生术后盆腔脓肿，需要再次手术。长期术后并发症包括黏膜脱垂、吻合口回缩和吻合口狭窄。LARS评分和Wexner评分的平均值分别为：术后6个月时33.7和16.2，术后12个月时28.5和11.7，术后24个月时21.1和6.7。结肠肛管袖状延迟吻合术似乎是避免特定患者永久性造口的有效方法。对于熟练的微创外科医生来说，腹腔镜手术是安全可行的。我们的经验描述了这些患者临床病史的复杂性，肠道连续性恢复后控便功能虽缓慢但呈渐进性改善。
