Clark David A, Yeoh Edward, Edmundson Aleksandra, Harris Craig, Stevenson Andrew, Steffens Daniel, Solomon Michael
Faculty of Medicine and Health, University of Sydney and Surgical Outcomes Research Centre (SOuRCe), Sydney, NSW, Australia.
Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Ann Coloproctol. 2022 Apr;38(2):124-132. doi: 10.3393/ac.2020.12.24. Epub 2021 Jan 11.
Anastomotic leakage (AL) is the anathema of colorectal surgery. Its occurrence leads to increased morbidity and mortality and a prolonged hospital stay. Much work has gone into studying various biomarkers in drain fluid to facilitate early detection of AL. This stage 2a development study aims to assess the safety and feasibility of reliably detecting the iodine in Gastrografin (GG; Bayer Australia Ltd.) in drain fluid and stool samples by dual-energy computed tomography (DECT).
This is a prospective, observational, controlled, consecutive cohort study establishing the safety and feasibility of the detection of GG in surgical drain fluid and stool as a biomarker of AL when patients with a low pelvic colorectal anastomosis undergo luminal flushing of the rectal tube with GG.
Ten consecutive patients were allocated to the saline flush group and the following 10 to the GG flush group. Three patients in the saline flush group developed an AL. One patient in the GG flush group developed an AL. An elevation in the drain fluid GG was detected using DECT on the day of clinical deterioration. None of the patients in the control group were found to have a positive result on DECT.
This study demonstrates the safety of a novel approach to the early detection of AL from extraperitoneal colorectal anastomoses. The technique requires validation in a larger cohort and a multicenter study is planned to investigate the efficacy of GG rectal tube flushes as an early biomarker of AL in low pelvic anastomoses.
吻合口漏（AL）是结直肠手术的大忌。其发生会导致发病率和死亡率增加以及住院时间延长。为促进AL的早期检测，人们已开展大量工作来研究引流液中的各种生物标志物。这项2a期开发研究旨在评估通过双能计算机断层扫描（DECT）可靠检测引流液和粪便样本中泛影葡胺（GG；拜耳澳大利亚有限公司）中碘的安全性和可行性。
这是一项前瞻性、观察性、对照、连续队列研究，旨在确定当低位盆腔结直肠吻合术患者用GG对直肠管进行腔内冲洗时，检测手术引流液和粪便中GG作为AL生物标志物的安全性和可行性。
连续10例患者被分配到生理盐水冲洗组，接下来的10例被分配到GG冲洗组。生理盐水冲洗组有3例患者发生AL。GG冲洗组有1例患者发生AL。在临床病情恶化当天，使用DECT检测到引流液中GG升高。对照组中没有患者在DECT检查中呈阳性结果。
本研究证明了一种从腹膜外结直肠吻合口早期检测AL的新方法的安全性。该技术需要在更大的队列中进行验证，计划开展一项多中心研究来调查GG直肠管冲洗作为低位盆腔吻合口中AL早期生物标志物的有效性。
