Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, 010-8543, Japan.
Sci Rep. 2020 Sep 24;10(1):15616. doi: 10.1038/s41598-020-72619-x.
The incidence of anastomotic leakage after esophagectomy remains around 10%. It was previously reported that PDSII rapidly loses tensile strength at pH 1.0 and pH 8.5. By contrast, LACLON degradation is reportedly insensitive to pH. We therefore compared LACLON with PDSII for esophago-gastric conduit, layer-to-layer, handsewn anastomosis. Between January 2016 and January 2020, 90 patients who received posterior mediastinal gastric conduit reconstruction with layer-to-layer handsewn anastomosis (51 using PDSII and 39 using LACLON) at Akita University Hospital were enrolled. The incidence of anastomotic leakage was significantly lower in the LACLON (2.6%, 1/39 patients) than PDSII group (15.7%, 8/51 patients) (p = 0.0268). Multivariable logistic analysis showed the risk of anastomotic leakage was significantly greater with PDSII than LACLON (odds ratio 11.01; 95% CI 1.326-277.64; p = 0.024). The percentages of time the pH was higher than 8 on the gastric conduit side of the anastomosis were 3.1%, 5.7%, 20.9% and 80.5%, respectively, in the four most recent patients. The present study showed that pH at the anastomosis soon after esophagectomy tends to be alkaline rather than acidic, which raises the possibility that this alkalinity facilitates the deterioration of surgical sutures including PDSII.
食管切除术后吻合口漏的发生率仍约为 10%。先前有报道称，PDSII 在 pH 值为 1.0 和 8.5 时会迅速丧失拉伸强度。相比之下，LACLON 的降解据称对 pH 值不敏感。因此，我们比较了 LACLON 和 PDSII 在食管胃吻合术中的应用。2016 年 1 月至 2020 年 1 月，在秋田大学医院接受后纵隔胃管重建、层间手工吻合的 90 例患者被纳入研究。LACLON 组（2.6%，1/39 例）吻合口漏的发生率明显低于 PDSII 组（15.7%，8/51 例）（p=0.0268）。多变量逻辑分析显示，PDSII 组吻合口漏的风险明显高于 LACLON 组（比值比 11.01；95%置信区间 1.326-277.64；p=0.024）。最近的 4 例患者吻合口胃侧的 pH 值高于 8 的时间百分比分别为 3.1%、5.7%、20.9%和 80.5%。本研究表明，食管切除术后吻合口附近的 pH 值趋于碱性而不是酸性，这增加了这种碱性环境可能促进包括 PDSII 在内的手术缝线恶化的可能性。
