Zhang Weicheng, Tou Jinfa
Department of Neonatal Surgery, Zhejiang University School of Medicine Children's Hospital, Hangzhou, Zhejiang, China.
World J Pediatr Surg. 2023 Jun 26;6(3):e000533. doi: 10.1136/wjps-2022-000533. eCollection 2023.
Digestive perianastomotic ulceration (DPAU) is a rare complication after intestinal resection and anastomosis occurring at or near the anastomosis site. The purpose of this review is to summarize the characteristics of DPAU, including the etiology, diagnosis and differential diagnosis, clinical manifestations, treatment, and future research. All recent literature on DPAU was searched in PubMed, Embase, and Cochrane and then reviewed. The clinical manifestations of DPAU are mainly gastrointestinal symptoms such as bloody stool and chronic anemia. The diagnosis of DPAU is difficult. Specific diseases, such as Crohn's disease, must be ruled out before a diagnosis can be made. In addition, there are no clear treatment guidelines due to the high degree of heterogeneity in response to drugs and surgery. It is recommended to adjust medication in time and combine various treatment methods. In addition, the mechanism that causes DPAU is not well understood; however, several possible mechanisms have been proposed, such as scar tissue ischemia and underlying diseases. Moreover, there is a high risk of relapses, and a long-term follow-up is necessary. Numerous issues remain to be solved in this area; therefore, more randomized controlled trials and studies should be carried out to further understand this disease.
消化性吻合口周围溃疡(DPAU)是肠道切除吻合术后发生于吻合口处或其附近的一种罕见并发症。本综述的目的是总结DPAU的特点,包括病因、诊断与鉴别诊断、临床表现、治疗及未来研究方向。检索了PubMed、Embase和Cochrane中所有关于DPAU的最新文献并进行综述。DPAU的临床表现主要为便血和慢性贫血等胃肠道症状。DPAU的诊断较为困难,在做出诊断前必须排除诸如克罗恩病等特定疾病。此外,由于药物和手术反应的高度异质性,目前尚无明确的治疗指南。建议及时调整用药并联合多种治疗方法。此外,导致DPAU的机制尚不清楚;然而,已经提出了几种可能的机制,如瘢痕组织缺血和基础疾病。而且,复发风险高,需要长期随访。该领域仍有许多问题有待解决;因此,应开展更多随机对照试验和研究以进一步了解这种疾病。