Clark David A, Stephensen Bree, Edmundson Aleksandra, Steffens Daniel, Solomon Michael
Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Surgical Outcomes Research Centre (SOuRCe), Camperdown, Australia.
Ann Coloproctol. 2021 Oct;37(5):337-345. doi: 10.3393/ac.2020.09.14.1. Epub 2020 Sep 18.
Anastomotic leak (AL) after a low pelvic anastomosis is a devastating complication, with short- and long-term morbidity and increased mortality. Surgeons may employ various adjuncts in an attempt to reduce AL rates or mitigate their impact. These include the use of temporary diverting ileostomy (TDI), transanal or rectal tubes and pelvic drains. This questionnaire evaluates the preferences and routine use of these adjuncts in Australasian colorectal surgeons.
A cross-sectional survey was administered to Australian and New Zealand colorectal surgeons on September 20, 2018. The study survey consisted of 15 questions exploring basic demographics and the number of rectal resections and ileal pouches performed in 12 months, along with the surgeon's preference for the use of diverting stomas, rectal tubes, and pelvic drains.
There were 90 respondents to the survey (31.6%). Surgeons in Western Australia (71.4%) were more likely to use a mandatory TDI in colorectal extraperitoneal anastomoses than surgeons in Queensland (14.3%). South Australian surgeons are more likely to employ a mandatory TDI (100%) for ileal pouches than Queensland surgeons (42.9%). Rectal tubes are not commonly utilized (40.0% never use them), and pelvic drains are (45.6% in all cases). Surgeons consider a median AL rate of 15% was felt to justify the use of a TDI in low pelvic anastomoses and a median AL rate of 10% for ileal pouches.
There is considerable geographical variation in colorectal surgical practice throughout Australia and New Zealand. While surgeons interrogate the same literature, there are presumably other factors that see translation into variations in clinical practice.
低位盆腔吻合术后的吻合口漏（AL）是一种严重的并发症，会导致短期和长期发病，并增加死亡率。外科医生可能会采用各种辅助手段来试图降低AL发生率或减轻其影响。这些手段包括使用临时性转流回肠造口术（TDI）、经肛门或直肠管以及盆腔引流管。本问卷评估了这些辅助手段在澳大利亚和新西兰结直肠外科医生中的使用偏好和常规使用情况。
2018年9月20日对澳大利亚和新西兰的结直肠外科医生进行了一项横断面调查。该研究调查包括15个问题，涉及基本人口统计学信息、12个月内进行的直肠切除术和回肠袋手术数量，以及外科医生对使用转流造口、直肠管和盆腔引流管的偏好。
共有90名受访者（31.6%）。西澳大利亚州的外科医生（71.4%）比昆士兰州的外科医生（14.3%）更有可能在结直肠腹膜外吻合术中使用强制性TDI。南澳大利亚州的外科医生比昆士兰州的外科医生（42.9%）更有可能在回肠袋手术中使用强制性TDI（100%）。直肠管并不常用（40.0%的人从未使用过），而盆腔引流管则常用（所有病例中有45.6%使用）。外科医生认为，低位盆腔吻合术中AL发生率中位数为15%时使用TDI是合理的，回肠袋手术中AL发生率中位数为10%时使用TDI是合理的。
澳大利亚和新西兰各地的结直肠外科手术实践存在相当大的地域差异。虽然外科医生查阅的是相同的文献，但可能还有其他因素导致临床实践出现差异。
