General Surgery Unit, San Leonardo Hospital, Castellammare di Stabia, ASL NA3 Sud, Viale Europa, 283, 80053, Naples, Italy.
General Surgery Unit, Department of Advanced Biomedical Sciences, University Federico II, San Leonardo Hospital, Castellammare di Stabia, ASL NA3 Sud, Naples, Italy.
Updates Surg. 2021 Apr;73(2):495-502. doi: 10.1007/s13304-021-01022-6. Epub 2021 Mar 16.
Despite advances in coloanal anastomosis techniques, satisfactory procedures completed without complications remain lacking. We investigated the effectiveness of our recently developed 'Short stump and High anastomosis Pull-through' (SHiP) procedure for delayed coloanal anastomosis without a stoma. In this retrospective study, we analysed functional outcomes, morbidity, and mortality rates and local recurrence of 37 patients treated using SHiP procedure, out of the 282 patients affected by rectal cancer treated in our institution between 2012 and 2020. The inclusion criterion was that the rectal cancer be located within 4 cm from the anal margin. One patient died of local and pulmonary recurrence after 6 years, one developed lung and liver metastases after 2 years, and one experienced local recurrence 2.5 years after surgery. No major leak, retraction, or ischaemia of the colonic stump occurred; the perioperative mortality rate was zero. Five patients (13.51%) had early complications. Stenosis of the anastomosis, which occurred in nine patients (24.3%), was the only long-term complication; only three (8.1%) were symptomatic and were treated with endoscopic dilation. The mean Wexner scores at 24 and 36 months were 8.3 and 8.1 points, respectively. At the 36-month check-up, six patients (24%) had major LARS, ten (40%) had minor LARS, and nine (36%) had no LARS. The functional results in terms of LARS were similar to those previously reported after immediate coloanal anastomosis with protective stoma. The SHiP procedure resulted in a drastic reduction in major complications, and none of the patients had a stoma.
尽管结肠直肠吻合技术取得了进展，但仍缺乏能够顺利完成且无并发症的满意手术。我们研究了我们最近开发的“短残端和高位经肛门拖出术（SHiP）”在无造口的延迟结肠直肠吻合中的效果。在这项回顾性研究中，我们分析了功能结果、发病率、死亡率和局部复发率，纳入的 37 名患者接受了 SHiP 手术，这些患者是我们机构在 2012 年至 2020 年间治疗的 282 名直肠癌患者中的一部分。纳入标准为直肠癌位于距肛门边缘 4cm 以内。1 例患者在 6 年后死于局部和肺复发，1 例患者在 2 年后发生肺和肝转移，1 例患者在手术后 2.5 年后发生局部复发。无结肠残端主要漏、回缩或缺血；围手术期死亡率为零。5 名患者（13.51%）发生早期并发症。吻合口狭窄发生在 9 名患者（24.3%）中，是唯一的长期并发症；仅有 3 名（8.1%）有症状，经内镜扩张治疗。24 个月和 36 个月时的平均 Wexner 评分分别为 8.3 和 8.1 分。在 36 个月的检查中，6 名患者（24%）有主要 LARS，10 名（40%）有次要 LARS，9 名（36%）无 LARS。LARS 的功能结果与先前报道的保护性造口即时结肠直肠吻合术相似。SHiP 手术显著降低了主要并发症的发生率，且无患者行造口术。
