De Robles Marie Shella, Young Christopher John
Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
Discipline of Surgery, The University of Sydney, Sydney, Australia.
Ann Coloproctol. 2021 Feb;37(1):16-20. doi: 10.3393/ac.2019.06.30. Epub 2020 Feb 5.
Stapled anastomotic techniques to the distal rectum have gained widespread acceptance due to their procedural advantages. Various modifications in the stapling techniques have evolved since their inception. The triple-staple technique utilizing stapled closure of both the proximal colon and distal rectal stump provides a rapid and secure colorectal anastomosis. The aims of this study were to determine the safety and efficacy of the triple-staple technique and to compare the clinical outcomes with a historical control group for which the conventional double-staple technique had been performed.
One hundred consecutive patients operated on by a single surgeon were included in the study; 50 patients who underwent a double-staple (DSA) procedure and 50 patients undergoing triple-staple anastomosis (TSA).
The most common indication for surgery in both groups was rectal cancer followed by diverticular disease and distal sigmoid cancer. There was no significant difference in number of patients requiring loop ileostomy formation in the groups (TSA, 56.0% vs. DSA, 68.0%; P = 0.621). The mean operating time for the TSA group was significantly shorter compared to that of the DSA group (TSA, 242.8 minutes vs. DSA, 306.1 minutes; P = 0.001). There was no significant difference in complication rate (TSA, 40% vs. DSA, 50%; P = 0.315) or length of hospital stay between the two groups (TSA, 11.3 days vs. DSA, 13.0 days; P = 0.246). Postoperative complications included anastomotic leak, prolonged ileus, bleeding, wound infection, and pelvic collection.
The triple-staple technique is a safe alternative to double-staple anastomosis after anterior resection and effectively shortens operating time.
由于其操作优势，直肠远端吻合的吻合器技术已得到广泛认可。自问世以来，吻合器技术有了多种改进。利用近端结肠和远端直肠残端吻合器闭合的三重吻合技术可实现快速、安全的结直肠吻合。本研究的目的是确定三重吻合技术的安全性和有效性，并与采用传统双重吻合技术的历史对照组比较临床结果。
本研究纳入了由同一位外科医生连续手术的100例患者；50例行双重吻合（DSA）手术，50例行三重吻合（TSA）。
两组最常见的手术指征均为直肠癌，其次是憩室病和乙状结肠远端癌。两组中需要行袢式回肠造口术的患者数量无显著差异（TSA组为56.0%，DSA组为68.0%；P = 0.621）。TSA组的平均手术时间明显短于DSA组（TSA组为242.8分钟，DSA组为306.1分钟；P = 0.001）。两组的并发症发生率（TSA组为40%，DSA组为50%；P = 0.315）或住院时间无显著差异（TSA组为11.3天，DSA组为13.0天；P = 0.246）。术后并发症包括吻合口漏、肠梗阻延长、出血、伤口感染和盆腔积液。
三重吻合技术是前切除术双重吻合的安全替代方法，可有效缩短手术时间。
