吻合器高度和直肠壁厚度对腹腔镜低位前切除术后吻合口漏的影响。

The effect of staple height and rectal-wall thickness on anastomotic leakage after laparoscopic low anterior resection.

作者信息

Naoi Daishi, Horie Hisanaga, Sadatomo Ai, Koinuma Koji, Ota Gaku, Oshiro Kenichi, Tahara Makiko, Mori Katsusuke, Ito Homare, Inoue Yoshiyuki, Homma Yuko, Mimura Toshiki, Lefor Alan Kawarai, Sata Naohiro

机构信息

Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.

出版信息

Asian J Surg. 2023 Apr;46(4):1577-1582. doi: 10.1016/j.asjsur.2022.09.093. Epub 2022 Oct 8.

DOI:10.1016/j.asjsur.2022.09.093

PMID:36216667

Abstract

BACKGROUND

The aim of this study was to evaluate the effect of staple height and rectal wall thickness on the development of an anastomotic leak after laparoscopic low anterior resection performed with the double stapling technique.

METHODS

One hundred ninety-nine patients treated from 2013 to 2021 were enrolled. Patients were divided into two groups: those who developed an anastomotic leak (AL (+)) and those who did not (AL (-)). Clinicopathological factors were compared between the groups.

RESULTS

Anastomotic leaks were observed in 8/199 patients (4%). A 1.5 mm linear stapler was used for 35/199 patients (17%), 1.8 mm for 89 (45%), and 2 mm for 75 (38%). In the AL (+) group (n = 8), lower staple height (1.5 mm or 1.8 mm) was used more frequently than in the AL (-) group (n = 191). Rectal wall thickness and the rectal wall thickness to staple height ratio was significantly (p < .05) greater in the AL (+) group. However, rectal wall thickness was significantly (p < .05) greater in patients who received neoadjuvant treatment and those with advanced T stage (T3,4) lesions.

CONCLUSION

Linear stapler staple height and rectal wall thickness are significantly associated with the development of an anastomotic leak after laparoscopic low anterior resection. Larger staples should be selected in patients with a thicker rectal wall due to neoadjuvant treatment or adjacent advanced rectal tumors.

摘要

背景

本研究旨在评估在腹腔镜低位前切除术采用双吻合器技术时，吻合器钉高和直肠壁厚度对吻合口漏发生的影响。

方法

纳入2013年至2021年接受治疗的199例患者。患者分为两组：发生吻合口漏的患者（AL(+)）和未发生吻合口漏的患者（AL(-)）。比较两组之间的临床病理因素。

结果

199例患者中有8例（4%）发生吻合口漏。199例患者中35例（17%）使用1.5mm直线切割吻合器，89例（45%）使用1.8mm，75例（38%）使用2mm。在AL(+)组（n = 8）中，使用较低钉高（1.5mm或1.8mm）的频率高于AL(-)组（n = 191）。AL(+)组的直肠壁厚度和直肠壁厚度与钉高的比值显著更高（p <.05）。然而，接受新辅助治疗的患者和T分期较晚（T3、4）病变的患者直肠壁厚度显著更高（p <.05）。