Shupyk National University of Healthcare of Ukraine, Kyiv, Ukraine.
Communal Nonprofit Enterprise Kyiv City Clinical Oncology Center, Kyiv, Ukraine.
Int J Surg Oncol. 2024 Aug 10;2024:5562420. doi: 10.1155/2024/5562420. eCollection 2024.
Failure of low colorectal anastomosis remains challenging in surgical oncology, necessitating the exploration of new methods and improvements in existing preventive measures.
This prospective study was conducted in two stages: intraluminal pressure in the colon was monitored in 32 patients by manometry and sonography over a 5-day postoperative period; 213 patients who underwent anterior resection of the rectum were analyzed, of whom 126 and 87 underwent diverting stoma (DS) and transanal intubation (TAI), respectively.
The effectiveness of the recommended technique for applying and removing transanal intubation (TAI) to prevent pneumo hydro strike (≥15 kPa) on the anastomosis line was analyzed in 87 patients and compared with imposed DS. TAI showed better borderline statistical significance ( = 0.051). The incidence of repeat surgery for anastomotic failure (AL) was seven (5.55%) and four (4.59%) in the DS and TAI groups, respectively. The distance of the anastomosis from the dentate line <60 mm was associated with a higher risk of AL occurrence (odds ratio (OR), 1.012; 95% confidence interval (CI), 1.007-1.017; < 0.001; area under the curve (AUC) = 0.82). DS is recommended for men, as the risk of AL is significantly lower among women (OR, 0.41; 95% CI, 0.16-1.04; = 0.062; AUC, 0.61; 95% CI, 0.54-0.67).
Although TAI is advantageous over DS for preventing AL, surgeons select the method for the preventive approach based on the preoperative and intraoperative results.
低位结直肠吻合口失败仍然是外科肿瘤学面临的挑战，需要探索新的方法和改进现有的预防措施。
本前瞻性研究分两个阶段进行：通过测压和超声在术后 5 天内监测 32 例患者的结肠腔内压力；分析了 213 例接受直肠前切除术的患者，其中 126 例行预防性造口术（DS），87 例行经肛插管（TAI）。
在 87 例患者中分析了预防吻合线发生气液冲击（≥15kPa）的推荐经肛插管（TAI）应用和移除技术的效果，并与强制性 DS 进行了比较。TAI 显示出更好的边缘统计学意义（=0.051）。DS 和 TAI 组吻合口失败（AL）的再次手术发生率分别为 7 例（5.55%）和 4 例（4.59%）。吻合口距齿状线<60mm与 AL 发生率较高相关（优势比（OR），1.012；95%置信区间（CI），1.007-1.017；<0.001；曲线下面积（AUC）=0.82）。DS 推荐用于男性，因为女性的 AL 风险明显较低（OR，0.41；95%CI，0.16-1.04；=0.062；AUC，0.61；95%CI，0.54-0.67）。
尽管 TAI 在预防 AL 方面优于 DS，但外科医生会根据术前和术中的结果选择预防方法。
