Didolkar M S, Reed W P, Elias E G, Schnaper L A, Brown S D, Chaudhary S M
Cancer. 1986 Feb 1;57(3):456-60. doi: 10.1002/1097-0142(19860201)57:3<456::aid-cncr2820570309>3.0.co;2-3.
Eighty-eight cancer patients with the presence of one or more adverse factors for healing (carcinomatosis, adhesions, prior chemotherapy and radiation therapy, bowel obstruction, anemia, and low leukocyte count or albumin value) were prospectively randomized to undergo conventional two-layer hand suturing (45 patients) or mechanical stapling with a GIA/TA instrument (U.S. Surgical Corp., Norwalk, CT) (43 patients) of the large or small bowel anastomosis. Age, sex, complete blood count findings, and all biochemical plasma values were comparable in both groups. The anastomosis took an average of 19 minutes for the sutured and 9 minutes for the stapled technique (P = 0.0001), but the average length of operation, postoperative return of bowel function, and hospital stay were comparable in both groups. Bowel fistula was seen in one case of stapled anastomosis (P = not significant). The pulmonary and wound complication rates were the same in both groups. Of the four deaths (4.5%) due to causes unrelated to bowel anastomosis, three occurred in the stapled and one in the sutured group. It was concluded that a stapled anastomosis is as safe as a sutured one in patients with advanced-stage cancer. It saves time in anastomosis, but does not save time in postoperative return of the bowel function and hospital stay.
88例存在一种或多种愈合不良危险因素（癌性腹膜炎、粘连、既往化疗和放疗、肠梗阻、贫血以及白细胞计数或白蛋白值低）的癌症患者被前瞻性随机分组，分别接受常规两层手工缝合（45例患者）或使用GIA/TA器械（美国外科公司，诺沃克，康涅狄格州）进行小肠或大肠吻合的机械吻合术（43例患者）。两组患者的年龄、性别、全血细胞计数结果以及所有血浆生化值均具有可比性。吻合术采用缝合技术平均用时19分钟，采用吻合器技术平均用时9分钟（P = 0.0001），但两组患者的平均手术时长、术后肠道功能恢复情况以及住院时间具有可比性。吻合器吻合组有1例出现肠瘘（P = 无显著性差异）。两组的肺部和伤口并发症发生率相同。在因与肠吻合无关的原因导致的4例死亡（4.5%）中，3例发生在吻合器吻合组，1例发生在缝合组。研究得出结论，在晚期癌症患者中，吻合器吻合与缝合吻合一样安全。它在吻合过程中节省时间，但在术后肠道功能恢复和住院时间方面并未节省时间。
