Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Surg Today. 2020 Nov;50(11):1368-1374. doi: 10.1007/s00595-020-02022-6. Epub 2020 May 20.
To identify the incidence of and risk factors for postoperative bleeding after ileocolic end-to-side anastomosis using a circular stapler.
We analyzed, retrospectively, the risk factors for postoperative anastomotic bleeding in patients who underwent right-sided colectomy with end-to-side anastomosis done using a circular stapler during colon tumor surgery at our institute between January 2015 and March 2019.
Anastomotic bleeding developed in 10 (3.6%) of the total 279 patients. Univariate analysis revealed that age ≥ 80 years (8.8% vs. 1.9%; P = 0.008) and Eastern Cooperative Oncology Group performance status (ECOG PS) ≥ 1 (12.5% vs. 2.8%; P = 0.014) were significant risk factors for anastomotic bleeding. Postoperative anticoagulation therapy was not a risk factor for anastomotic bleeding. Multivariate analysis revealed that only age ≥ 80 years was an independent risk factor (odds ratio 4.12, 95% confidence interval 1.02-16.68, P = 0.047). Six of the ten patients with anastomotic bleeding were treated conservatively, three were treated by colonoscopic clipping, and one required surgery.
End-to-side anastomosis is safe and feasible, but must be performed carefully in the elderly, who are at higher risk of anastomotic bleeding.
使用圆形吻合器识别回肠-结肠端端吻合术后出血的发生率和危险因素。
我们回顾性分析了 2015 年 1 月至 2019 年 3 月期间在我院行结肠肿瘤手术时采用圆形吻合器行右侧结肠端端吻合术患者的术后吻合口出血的危险因素。
在 279 例患者中，有 10 例（3.6%）发生吻合口出血。单因素分析显示，年龄≥80 岁（8.8%比 1.9%；P=0.008）和东部肿瘤协作组体力状况（ECOG PS）≥1（12.5%比 2.8%；P=0.014）是吻合口出血的显著危险因素。术后抗凝治疗不是吻合口出血的危险因素。多因素分析显示，只有年龄≥80 岁是独立的危险因素（比值比 4.12，95%置信区间 1.02-16.68，P=0.047）。10 例吻合口出血患者中，6 例经保守治疗，3 例经结肠镜夹闭治疗，1 例需手术治疗。
端端吻合安全可行，但在老年人中必须小心操作，因为老年人吻合口出血的风险较高。
