Namba Yosuke, Mukai Shoichiro, Saito Yasufumi, Moriuchi Toshiyuki, Bekki Tomoaki, Okimoto Sho, Oishi Koichi, Fujisaki Seiji, Takahashi Mamoru, Fukuda Toshikatsu, Egi Hiroyuki, Ohdan Hideki
Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan.
Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
J Anus Rectum Colon. 2021 Apr 28;5(2):181-187. doi: 10.23922/jarc.2020-099. eCollection 2021.
Anastomotic leakage is associated with severe morbidity, mortality, and functional defects. Its risk factors remain unclear. However, blood perfusion may be a potential major risk factor. It has been reported that the Agatston score is an index for blood flow perfusion evaluation. Therefore, we evaluated the clinical indicators associated with anastomotic leakage, including the Agatston score, in patients who underwent colorectal surgery.
We retrospectively analyzed 147 patients who underwent elective colorectal surgery with the double-staple technique anastomosis for colorectal cancer between April 2015 and March 2020. The primary outcome was the presence or absence of anastomotic leakage. Univariate and multivariate analyses were employed to identify pre- and intraoperative risk factors.
Of the 147 patients analyzed, anastomotic leakage occurred in 12 (8.16%). Male gender, history of angina and myocardial infarction, preoperative white blood cell count, the Agatston score, extent of bleeding, operation time, and intraoperative fluid volume were significantly related to a higher incidence of anastomotic leakage in univariate analysis. Multivariate analysis demonstrated that the incidence of anastomotic leakage was high in patients with a high Agatston score.
The Agatston score can predict the incidence of anastomotic leakage in patients following colorectal surgery. Thus, perioperative measures to prevent anastomotic leakage are recommended when a high Agatston score is observed. A prospective trial is required to demonstrate, with a high level of evidence, that the Agatston score can be useful as a risk score for anastomotic leakage following colorectal surgery.
吻合口漏与严重的发病率、死亡率及功能缺陷相关。其危险因素尚不清楚。然而，血液灌注可能是一个潜在的主要危险因素。据报道，阿加斯顿评分是评估血流灌注的一个指标。因此，我们评估了接受结直肠手术患者中与吻合口漏相关的临床指标，包括阿加斯顿评分。
我们回顾性分析了2015年4月至2020年3月期间147例行择期结直肠癌双吻合器技术吻合术的患者。主要结局是有无吻合口漏。采用单因素和多因素分析来确定术前和术中的危险因素。
在分析的147例患者中，12例（8.16%）发生了吻合口漏。单因素分析显示，男性、心绞痛和心肌梗死病史、术前白细胞计数、阿加斯顿评分、出血程度、手术时间和术中液体量与吻合口漏发生率较高显著相关。多因素分析表明，阿加斯顿评分高的患者吻合口漏发生率高。
阿加斯顿评分可预测结直肠手术后患者吻合口漏的发生率。因此，当观察到阿加斯顿评分高时，建议采取围手术期措施预防吻合口漏。需要进行一项前瞻性试验，以高水平证据证明阿加斯顿评分可作为结直肠手术后吻合口漏的风险评分。
