Goldman G, Aladgem D, Kahn P J, Wiznitzer T
Department of Surgery A, Ichilov Hospital, Tel Aviv University, Israel.
Eur Surg Res. 1988;20(4):238-42. doi: 10.1159/000128767.
The most common causes for morbidity and mortality in colorectal resections are anastomotic leaks. In low anterior resection, the incidence of anastomotic leakage ranges from 17 to 50%. With the use of the stapler technique, leakage incidence rate remains high and ranges from 10 to 25%. Colostomy formation and closures are associated with considerable morbidity and mortality. Due to the high incidence of anastomotic leakage rate in low anterior resection, and the additional complications of diverting colostomy formation and closure, the use of a rectal stent-intrarectal bypass graft has been instituted. This is carried out by means of a silastic graft, which prevents the fecal stream and gas pressure from coming into contact with the anastomotic site at the low rectum. The efficacy of intrarectal bypass graft was examined in two high-risk surgical situations, the first in very low anterior resection and the other, after early sigmoid obstruction. In both situations the intrarectal bypass graft provided for a safe anastomosis. Even when dehiscence and early obstructions occur, the tube may prevent leakage. This procedure presents effective practical implications which obviate the need for a proximal colostomy formation, thereby eliminating the physical and psychological stress that accompanies colostomies.
结直肠切除术中发病和死亡的最常见原因是吻合口漏。在低位前切除术中，吻合口漏的发生率为17%至50%。使用吻合器技术时，漏发生率仍然很高，为10%至25%。结肠造口的形成和关闭与相当高的发病率和死亡率相关。由于低位前切除术中吻合口漏发生率高，以及转流性结肠造口形成和关闭的额外并发症，已开始使用直肠支架-直肠内旁路移植物。这是通过硅橡胶移植物来实现的，它可防止粪流和气压与低位直肠的吻合口接触。在两种高风险手术情况下对直肠内旁路移植物的疗效进行了检查，第一种是在极低位前切除术中，另一种是在乙状结肠早期梗阻后。在这两种情况下，直肠内旁路移植物都实现了安全吻合。即使发生裂开和早期梗阻，该导管也可防止渗漏。该手术具有有效的实际意义，无需进行近端结肠造口术，从而消除了结肠造口术带来的身体和心理压力。
