在结肠癌和直肠癌的左侧结肠和直肠切除术中，端到端或侧到端吻合构型是否与术中空气泄漏试验阳性风险相关？
Is end-to-end or side-to-end anastomotic configuration associated with risk of positive intraoperative air leak test in left-sided colon and rectal resections for colon and rectal cancers?
作者信息
Alahmadi Sami, Berger David L, Cauley Christy E, Goldstone Robert N, Kastrinakis William V, Rubin Marc, Kunitake Hiroko, Ricciardi Rocco, Lee Grace C
机构信息
Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States.
Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Department of Surgery, Newton-Wellesley Hospital, Newton, MA, United States.
出版信息
J Gastrointest Surg. 2025 Feb;29(2):101899. doi: 10.1016/j.gassur.2024.101899. Epub 2024 Nov 26.
BACKGROUND
Anastomotic leak after colorectal resection is associated with morbidity, mortality, and poor bowel function. Minimal data exist on the relationship between anastomotic technique, intraoperative leak test, and subsequent clinical leak, particularly on the utility of performing end-to-end anastomosis (EEA) vs non-EEA (NEEA) to avoid postoperative leaks. This study aimed to analyze potential associations between anastomotic construction, intraoperative anastomotic assessments, and clinical leak.
METHODS
This was a retrospective cohort study comparing anastomotic techniques used in patients with colorectal cancer who underwent left-sided colorectal resections with colorectal or coloanal anastomoses at a tertiary care center. The outcomes were rates of intraoperative air leak, incomplete anastomotic donuts, and postoperative clinical leak. Univariate and multivariate analyses were performed to evaluate the potential association between anastomotic technique and intraoperative anastomotic assessments and subsequent leak.
RESULTS
Among 844 patients, 27 (3.2%) had intraoperative leak, 6 (0.7%) had incomplete donuts, and 27 (3.2%) experienced clinical leak. Of note, 500 patients (59.2%) had EEAs, and 344 patients (40.7%) had NEEAs. There were no significant differences in demographics or comorbidities between groups (P >.05) or rates of incomplete donuts (P =.07). EEA was associated with significantly more intraoperative air leaks than NEEA on univariate analysis (4.9% vs 1.2%, respectively; P =.005) and multivariate analysis (odds ratio [OR], 3.6; 95% CI, 1.01-12.50; P =.049). There was no difference in postoperative clinical leak between the groups on univariate analysis (3.0% in EEA vs 3.5% in NEEA; P =.69) or multivariate analysis (OR, 0.97; 95% CI, 0.40-2.34; P =.94).
CONCLUSION
EEA is associated with higher rates of intraoperative air leak than NEEA, even after adjusting for potential confounders.
背景
结直肠切除术后吻合口漏与发病率、死亡率及肠道功能不良相关。关于吻合技术、术中漏诊试验与后续临床漏诊之间关系的数据极少，尤其是关于行端端吻合（EEA）与非端端吻合（NEEA）以避免术后漏诊的效用。本研究旨在分析吻合口构建、术中吻合口评估与临床漏诊之间的潜在关联。
方法
这是一项回顾性队列研究，比较在一家三级医疗中心接受左侧结直肠切除并进行结直肠或结肠肛管吻合的结直肠癌患者所采用的吻合技术。观察指标为术中漏气率、吻合口环不完整率及术后临床漏诊率。进行单因素和多因素分析以评估吻合技术与术中吻合口评估及后续漏诊之间的潜在关联。
结果
在844例患者中，27例（3.2%）发生术中漏诊，6例（0.7%）吻合口环不完整，27例（3.2%）发生临床漏诊。值得注意的是，500例患者（59.2%）行EEA，344例患者（40.7%）行NEEA。两组间人口统计学特征或合并症无显著差异（P>.05），吻合口环不完整率也无显著差异（P =.07）。单因素分析显示，EEA组术中漏气显著多于NEEA组（分别为4.9%和1.2%；P =.005），多因素分析结果为（比值比[OR]，3.6；95%可信区间[CI]，1.01 - 12.50；P =.049）。单因素分析（EEA组为3.0%，NEEA组为3.5%；P =.69）及多因素分析（OR，0.97；95% CI，0.40 - 2.34；P =.94）显示两组术后临床漏诊无差异。
结论
即使在调整潜在混杂因素后，EEA组术中漏气率仍高于NEEA组。
Zotero 插件