是否应更多地考虑一期吻合术？一项关于幼儿吻合口并发症的回顾性分析。

Should primary anastomosis be considered more? A retrospective analysis of anastomotic complications in young children.

作者信息

Eeftinck Schattenkerk Laurens D, Musters Gijsbert D, de Jonge Wouter J, van Heurn L W Ernest, Derikx Joep Pm

机构信息

Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

出版信息

World J Pediatr Surg. 2023 Aug 31;6(4):e000565. doi: 10.1136/wjps-2023-000565. eCollection 2023.

DOI:10.1136/wjps-2023-000565

PMID:37671119

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10476123/

Abstract

OBJECTIVE

Little is known about intestinal anastomotic leakage and stenosis in young children (≤3 years of age). The purpose of this study is to answer the following questions: (1) what is the incidence of anastomotic stenosis and leakage in infants? (2) which surgical diseases entail the highest incidence of anastomotic stenosis and leakage? (3) what are perioperative factors associated with anastomotic stenosis and leakage?

METHODS

Patients who underwent an intestinal anastomosis during primary abdominal surgery in our tertiary referral centre between 1998 and 2018 were retrospectively included. Both general incidence and incidence per disease of anastomotic complications were determined. Technical risk factors (location and type of anastomosis, mode of suturing, and suture resorption time) were evaluated by multivariate Cox regression for anastomotic stenosis. Gender and American Society of Anaesthesiology (ASA) score of ≥III were evaluated by χ test for anastomotic leakage.

RESULTS

In total, 477 patients underwent an anastomosis. The most prominent diseases are intestinal atresia (30%), Hirschsprung's disease (29%), and necrotizing enterocolitis (14%). Anastomotic stenosis developed in 7% (34/468) of the patients with highest occurrence in necrotizing enterocolitis (14%, 9/65). Colonic anastomosis was associated with an increased risk of anastomotic stenosis (hazard ratio (HR) =3.6, 95% CI 1.8 to 7.5). No technical features (type of anastomosis, suture resorption time and mode of suturing) were significantly associated with stenosis development. Anastomotic leakage developed in 5% (22/477) of the patients, with the highest occurrence in patients with intestinal atresia (6%, 9/143). An ASA score of ≥III (p=0.03) and male gender (p=0.03) were significantly associated with anastomotic leakage.

CONCLUSIONS

Both anastomotic stenosis and leakage are major surgical complications. Identifying more patient specific factors can result in better treatment selection, which should not solely be based on the type of disease.

摘要

目的

关于幼儿（≤3岁）肠道吻合口漏和狭窄的情况，人们了解甚少。本研究的目的是回答以下问题：（1）婴儿吻合口狭窄和漏的发生率是多少？（2）哪些外科疾病导致吻合口狭窄和漏的发生率最高？（3）与吻合口狭窄和漏相关的围手术期因素有哪些？

方法

回顾性纳入1998年至2018年期间在我们三级转诊中心接受初次腹部手术时进行肠道吻合的患者。确定吻合口并发症的总体发生率和每种疾病的发生率。通过多变量Cox回归评估吻合口狭窄的技术风险因素（吻合口的位置和类型、缝合方式以及缝线吸收时间）。通过χ检验评估性别和美国麻醉医师协会（ASA）评分≥III与吻合口漏的关系。

结果

共有477例患者进行了吻合术。最常见的疾病是肠闭锁（30%）、先天性巨结肠（29%）和坏死性小肠结肠炎（14%）。7%（34/468）的患者发生了吻合口狭窄，其中坏死性小肠结肠炎的发生率最高（14%，9/65）。结肠吻合与吻合口狭窄风险增加相关（风险比（HR）=3.6，95%置信区间1.8至7.5）。没有技术特征（吻合方式、缝线吸收时间和缝合方式）与狭窄的发生显著相关。5%（22/477）的患者发生了吻合口漏，其中肠闭锁患者的发生率最高（6%，9/143）。ASA评分≥III（p=0.03）和男性（p=0.03）与吻合口漏显著相关。