Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
Department of Surgery, Kuwana City Medical Center, 3-11 Kotobuki-cho, Kuwana-shi, Mie, 511-0061, Japan.
Surg Today. 2023 Jul;53(7):753-761. doi: 10.1007/s00595-023-02643-7. Epub 2023 Feb 9.
To report our initiatives and treatment results for patients with colorectal cancer with metal allergy.
A total of 27 patients (2.6%) with a history of metal contact dermatitis were identified among 1027 patients who underwent curative resection of colorectal cancer from 2014 to 2020. The results of the patch test, perioperative results, and postoperative colonoscopy findings were also investigated.
The patch test for metal allergens and staples was performed in 21 patients (77.8%), and 13 of them (61.9%) tested positive for at least one metal allergen. Ni (38.1%), Co (28.6%), and Pd (19.0%) showed higher positive rates than other metals, and 1 patient (4.8%) tested positive for staples. Stapled anastomosis/suturing was performed as planned in 15 of 27 patients. In 10 patients, the anastomosis method was changed from stapled to hand-sewn according to the no-patch test results (60%), positivity for multiple metals (20%), positivity for staples (10%), and surgeon's judgment (10%). No complications and abnormal colonoscopy findings were found to be associated with stapled anastomosis/suturing.
The patch test is useful for selecting an optimal anastomosis method for patients with suspected metal allergy.
报告我们对有金属过敏史的结直肠癌患者的治疗措施和结果。
2014 年至 2020 年，对 1027 例接受结直肠癌根治性切除术的患者进行了回顾性研究，共发现 27 例（2.6%）有金属接触性皮炎病史。还调查了斑贴试验、围手术期结果和术后结肠镜检查结果。
对 21 例患者（77.8%）进行了金属过敏原和吻合钉的斑贴试验，其中 13 例（61.9%）至少对 1 种金属过敏原呈阳性。镍（38.1%）、钴（28.6%）和钯（19.0%）的阳性率高于其他金属，1 例（4.8%）对吻合钉呈阳性。27 例患者中，15 例按计划进行吻合钉吻合/缝合。根据无斑贴试验结果（60%）、多种金属阳性（20%）、吻合钉阳性（10%）和外科医生判断（10%），有 10 例患者将吻合方法从吻合钉改为手工缝合。未发现吻合钉吻合/缝合与并发症和结肠镜检查异常有关。
斑贴试验有助于为疑似金属过敏的患者选择最佳的吻合方法。
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