Laxamana A, Solomon M J, Cohen Z, Feinberg S M, Stern H S, McLeod R S
Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
Dis Colon Rectum. 1995 Dec;38(12):1246-50. doi: 10.1007/BF02049147.
This study was designed to determine the anastomotic leak rate, local recurrence rate, and survival of patients undergoing anterior resection with the double-stapling technique for rectal cancer.
Between 1981 and 1992, 189 patients underwent a curative (166) or palliative (23) anterior resection using the double-stapling technique. A chart review was performed, and follow-up information was obtained from the patient or family physician. Follow-up was complete in 186 patients (98 percent).
There were five (2.6 percent) stapler-related complications, of which two patients required a defunctioning colostomy. Postoperative mortality was 1.6 percent, and clinical leak rate was 7.3 percent. Clinical leak rate was significantly higher in patients with lesions in the lower third (20 percent) compared with those in the middle and upper thirds (9 and 1 percent, respectively; P < 0.05). After a mean follow-up of 32 +/- 29 months, local recurrence rate was 9.1 percent but was significantly higher in patients more than 65 years old (14 vs. 1 percent; P < 0.005) and in patients with resection margins less than 2.0 cm (17 vs. 5.5 percent; P < 0.05). Five-year survival was 78 percent.
Anterior resection performed with the double-stapling technique has an acceptable clinical leak rate, local recurrence rate, and survival rate. However, the clinical leak rate appears to be increased in patients with low tumors and, therefore, a defunctioning colostomy should be considered. Resection margins of more than 2 cm are necessary.
本研究旨在确定采用双吻合器技术行直肠癌前切除术患者的吻合口漏发生率、局部复发率及生存率。
1981年至1992年间，189例患者采用双吻合器技术行根治性（166例）或姑息性（23例）前切除术。进行了病历回顾，并从患者或家庭医生处获取随访信息。186例患者（98%）完成随访。
发生5例（2.6%）与吻合器相关的并发症，其中2例患者需要行造口转流术。术后死亡率为1.6%，临床漏发生率为7.3%。与肿瘤位于中、上三分之一的患者（分别为9%和1%）相比，肿瘤位于下三分之一的患者临床漏发生率显著更高（20%；P<0.05）。平均随访32±29个月后，局部复发率为9.1%，但65岁以上患者（14%对1%；P<0.005）及切缘小于2.0 cm的患者（17%对5.5%；P<0.05）局部复发率显著更高。5年生存率为78%。
采用双吻合器技术行前切除术具有可接受的临床漏发生率、局部复发率和生存率。然而，低位肿瘤患者的临床漏发生率似乎有所增加，因此应考虑行造口转流术。切缘需超过2 cm。
