Sell Naomi M, Francone Todd D
Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Department of Surgery, Newton-Wellesley Hospital, Newton, Massachusetts.
Clin Colon Rectal Surg. 2021 Nov 23;34(6):385-390. doi: 10.1055/s-0041-1735269. eCollection 2021 Nov.
Anastomotic leak remains a critical and feared complication in colorectal surgery. The development of a leak can be catastrophic for a patient, resulting in overall increased morbidity and mortality. To help mitigate this risk, there are several ways to assess and potentially validate the integrity of a new anastomosis to give the patient the best chance of avoiding this postoperative complication. A majority of anastomoses will appear intact with no obvious sign of anastomotic dehiscence on gross examination. However, each anastomosis should be interrogated before the conclusion of an operation. The most common method to assess for an anastomotic leak is the air leak test (ALT). The ALT is a safe intraoperative method utilized to test the integrity of left-sided colon and rectal anastomoses and most importantly allows the ability to repair a failed test before concluding the operation. Additional troubleshooting is sometimes needed due to technical difficulties with the circular stapler. Problems, such as incomplete doughnuts and stapler misfiring, do occur and each surgeon should be prepared to address them.
吻合口漏仍然是结直肠手术中一种严重且令人担忧的并发症。漏的发生对患者来说可能是灾难性的，会导致总体发病率和死亡率增加。为了帮助降低这种风险，有几种方法可以评估并可能验证新吻合口的完整性，以使患者有最大机会避免这种术后并发症。大多数吻合口在大体检查时看起来完好，没有明显的吻合口裂开迹象。然而，在手术结束前，应对每个吻合口进行检查。评估吻合口漏最常用的方法是漏气试验（ALT）。ALT是一种安全的术中方法，用于测试左侧结肠和直肠吻合口的完整性，最重要的是，它能在手术结束前对测试失败的情况进行修复。由于圆形吻合器存在技术难题，有时还需要进行额外的故障排除。诸如钉圈不完整和吻合器击发故障等问题确实会发生，每位外科医生都应做好应对准备。
