Cortina Chandler S, Alex Gillian C, Vercillo Kristin N, Fleetwood Vidyaratna A, Smolevitz Jill B, Poirier Jennifer, Myers Jonathan A, Orkin Bruce A, Singer Marc A
Am Surg. 2019 Feb 1;85(2):136-141.
Anastomotic leak after lower gastrointestinal surgery is a complication with potential for high morbidity, mortality, and increased costs. A single-institution retrospective chart review was performed on all patients who underwent lower gastrointestinal surgery between June 2009 and June 2013. Fifty-seven variables were included in our analysis and their association with postoperative anastomotic leak was examined. Nine hundred fifty-two patients underwent 983 lower gastrointestinal anastomoses with an overall leak rate in this series of 6 per cent. Type of intestinal anastomosis created ( < 0.00005), operative indication ( < 0.015), operation performed ( < 0.014), intraoperative blood transfusion ( < 0.017), and intraoperative surgical drain placement ( < 0.022) were all predictive of anastomotic leak. Anastomotic leak rate increased by 1.3 times for every additional hour in the operating room after three hours. Both increasing operation time and intraoperative blood transfusions were associated with an increased rate of anastomotic leak. When operative time extends beyond three hours or in those cases were blood transfusions are given, surgeons should consider taking steps to minimize the risks of a potential anastomotic leak.
下消化道手术后吻合口漏是一种可能导致高发病率、高死亡率和成本增加的并发症。对2009年6月至2013年6月期间接受下消化道手术的所有患者进行了单机构回顾性病历审查。我们的分析纳入了57个变量，并检查了它们与术后吻合口漏的关联。952例患者进行了983次下消化道吻合术，本系列的总体漏率为6%。所创建的肠吻合类型（<0.00005）、手术指征（<0.015）、所进行的手术（<0.014）、术中输血（<0.017）和术中放置手术引流管（<0.022）均为吻合口漏的预测因素。手术三小时后，在手术室每多待一小时，吻合口漏率增加1.3倍。手术时间延长和术中输血均与吻合口漏率增加相关。当手术时间超过三小时或进行输血的情况下，外科医生应考虑采取措施将潜在吻合口漏的风险降至最低。
