Rudnicki Yaron, White Ian, Benjamin Barak, Lahav Lauren, Shpitz Baruch, Avital Shmuel
Department of Surgery B, Meir Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr Med Assoc J. 2020 Jul;22(7):435-440.
Following an intestinal anastomotic leak, stoma creation may be the safest approach. However, this method may be challenging and cause significant morbidity. In selected cases, a T drain approach can be beneficial and a stoma can be avoided.
To present one group's experience with a T drain approach for anastomotic leaks.
Data on patients who underwent emergent re-laparotomy following gastrointestinal anastomotic leaks were retrieved retrospectively and assessed with a new intra-operative leak severity score.
Of 1684 gastrointestinal surgeries performed from 2014 to 2018, 41 (2.4%) cases of anastomotic leaks were taken for re-laparotomy. Cases included different sites and etiologies. Twelve patients were treated with a T-tube drain inserted through the leak site, 18 had a stoma taken out, 6 re-anastomosis, 4 were treated with an Endosponge, and one primary repair with a proximal ileostomy was conducted. T drain approach was successful in 11 of 12 patients (92%) with full recovery. One patient did not improve and underwent reoperation with resection and re-anastomosis. A severity score of anastomotic integrity is provided to help surgeons in decision making.
A T drain approach can be an optimal solution in selected cases following an intestinal anastomotic leak. When the leak is limited, the remaining anastomosis is intact and the abdominal environment allows it, a T drain can be used and a stoma can be avoided.
肠道吻合口漏发生后，造口术可能是最安全的处理方法。然而，这种方法可能具有挑战性，并会导致显著的发病率。在某些特定情况下，T管引流法可能有益且可避免造口。
介绍一组采用T管引流法处理吻合口漏的经验。
回顾性检索胃肠道吻合口漏后接受急诊再次剖腹手术患者的数据，并采用新的术中漏口严重程度评分进行评估。
2014年至2018年共进行了1684例胃肠道手术，其中41例（2.4%）吻合口漏患者接受了再次剖腹手术。病例包括不同部位和病因。12例患者通过漏口部位插入T管引流进行治疗，18例进行了造口，6例进行了再次吻合，4例采用海绵栓治疗，1例进行了近端回肠造口的一期修复。12例患者中有11例（92%）T管引流法成功，患者完全康复。1例患者病情未改善，接受了切除和再次吻合的再次手术。提供了吻合口完整性严重程度评分以帮助外科医生进行决策。
对于肠道吻合口漏后的某些特定病例，T管引流法可能是最佳解决方案。当漏口局限、剩余吻合口完整且腹腔环境允许时，可采用T管引流并避免造口。
