Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA.
Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA.
Am J Surg. 2020 Jun;219(6):998-1005. doi: 10.1016/j.amjsurg.2019.07.030. Epub 2019 Jul 25.
Despite a lack of supporting data, routine splenic flexure mobilization (SFM) during colectomy has been thought to reduce anastomotic leak (AL). We evaluated the impact of SFM on outcomes in distal colectomy.
The 2005-2016 NSQIP database identified 66,068 patients undergoing distal colectomy with anastomosis. Cohorts were stratified by addition of SFM. Postoperative outcomes were compared between groups. Regression analysis identified factors affecting odds of developing AL.
SFM was performed in 27,475 patients (41.6%). There was no difference in overall complications between cases with SFM and those without (p = 0.55). SFM had longer operative times (220 min vs. 184 min; p < 0.0001). SFM was not associated with any difference in AL rate (3.6% vs. 3.7%; p = 0.86). Factors most associated with AL were lack of oral antibiotic preparation (OR 1.93; p < 0.001), chemotherapy (OR 1.91; p < 0.001), and weight loss (OR 1.68; p = 0.0005). Operative indication and approach did not affect leak.
SFM in distal colectomy increased operative time without decreasing overall complications or AL. Routine splenic flexure mobilization may add risk without significant benefit.
尽管缺乏支持数据，但在结肠切除术时常规进行脾曲游离（SFM）被认为可以降低吻合口漏（AL）的风险。我们评估了 SFM 对远端结肠切除术结果的影响。
2005-2016 年 NSQIP 数据库确定了 66068 例接受远端结肠吻合术的患者。通过添加 SFM 对队列进行分层。比较组间术后结果。回归分析确定了影响 AL 发生几率的因素。
SFM 用于 27475 例患者（41.6%）。SFM 组和非 SFM 组之间的总体并发症发生率无差异（p=0.55）。SFM 组的手术时间较长（220 分钟 vs. 184 分钟；p<0.0001）。SFM 与 AL 发生率无差异（3.6% vs. 3.7%；p=0.86）。与 AL 最相关的因素是缺乏口服抗生素准备（OR 1.93；p<0.001）、化疗（OR 1.91；p<0.001）和体重减轻（OR 1.68；p=0.0005）。手术指征和方法不影响漏。
SFM 增加了远端结肠切除术的手术时间，但并未降低总体并发症或 AL 的发生率。常规进行脾曲游离可能会增加风险而没有显著获益。
