Cho Sung Hwan, Kim Hyun Sung, Park Byung-Soo, Son Gyung Mo, Park Su Bum, Yun Mi Sook
Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, 20 Geumo-Ro, Yangsan-Si, Gyeongsangnam-Do, 50612, Republic of Korea.
Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, 20 Geumo-Ro, Yangsan-Si, Gyeongsangnam-Do, 50612, Republic of Korea.
BMC Surg. 2025 Mar 27;25(1):116. doi: 10.1186/s12893-025-02836-6.
The aim of this study is to evaluate the utilization of intraoperative colonoscopy (IOC) for determining the integrity of the anastomosis and to establish an IOC scoring system.
A retrospective cohort study was conducted from January 2021 to June 2024, we analyzed the clinical data of 160 patients registered in a database who underwent laparoscopic left-sided colectomy at Pusan National University Yangsan Hospital. IOC was performed on all patients, and Mucosal color (MC), stapled line bleeding (BL), proximal redundancy (PR), and bowel preparation (BP) were evaluated and scored as variables. Logistic regression analysis was used to evaluate risk factors for anastomotic leakage (AL) and Cohen's kappa was applied to assess the reproducibility of the evaluation.
Of 160 patients, 10 (6.25%) experienced AL. All the IOC variables had kappa values of 0.8 or higher, indicating good agreement. The logistic regression analysis revealed significant differences in the MC 2 (P = 0.017, OR 12.86), PR 2 (P = 0.001, OR 27.64), BP 2 (p = 0.016, OR 10.50) PR 2 score (P = 0.016, OR 10.50) and the sum of the scores (p = 0.001, OR 3.51).
IOC can be performed as a reference procedure to assess the integrity of the anastomosis during left-sided colorectal surgery.
本研究旨在评估术中结肠镜检查（IOC）在确定吻合口完整性方面的应用，并建立一种IOC评分系统。
进行一项回顾性队列研究，时间跨度为2021年1月至2024年6月，我们分析了釜山国立大学梁山医院数据库中160例行腹腔镜左侧结肠切除术患者的临床资料。所有患者均接受了IOC检查，并对黏膜颜色（MC）、吻合钉线出血（BL）、近端冗余（PR）和肠道准备（BP）进行评估并作为变量评分。采用逻辑回归分析评估吻合口漏（AL）的危险因素，并应用Cohen's kappa评估评估的可重复性。
160例患者中，10例（6.25%）发生了AL。所有IOC变量的kappa值均为0.8或更高，表明一致性良好。逻辑回归分析显示，MC 2（P = 0.017，OR 12.86）、PR 2（P = 0.001，OR 27.64）、BP 2（p = 0.016，OR 10.50）、PR 2评分（P = 0.016，OR 10.50）和总分（p = 0.001，OR 3.51）存在显著差异。
IOC可作为评估左侧结直肠手术中吻合口完整性的参考程序。
