Detry R J, Kartheuser A, Delriviere L, Saba J, Kestens P J
Department of Digestive Surgery, University Hospital St-Luc, Brussels, Belgium.
Surgery. 1995 Feb;117(2):140-5. doi: 10.1016/s0039-6060(05)80077-7.
This study was performed to assess the exact performance of the conventional way of stapling colorectal anastomoses. Information collected from 1000 consecutive anastomoses performed by one surgical team could be considered as reliable reference with which results obtained by new approaches could be compared.
One thousand consecutive anastomoses were performed from 1979 to 1992. Characteristics of the procedure, intraoperative events, mortality rate, complications, and clinical outcome were detailed.
There were 528 men and 472 women (age range, 20 to 90 years; average age, 63 years). Anastomoses were constructed by means of a circular stapler loaded with the largest cartridge in 82.3% of the cases. Imperfections were identified during operation in 124 cases. A diverting colostomy was performed in 127 cases. Postoperative mortality rate averaged 2.2%. Clinical anastomotic leaks developed in 35 patients: in 11.4% after low stapling (less than 5 cm from the dentate line) and in 2.2% after high stapling. The presence of a diverting colostomy influenced the leakage rate in patients with very low anastomoses. Total failure rate (death, definitive colostomy) as a result of anastomotic leak was 1.6%. Among the 933 survivors who had follow-up examination, the incidence of bad functional results decreased from 10% at the first attendance to 4.3% at the last one. Transanal dilatation and restapling were required for symptomatic narrowing in three and one patients, respectively.
The conventional way of stapling colorectal anastomoses in reliable, but it requires strict observance of the rules for anastomosing intestine and a careful check of the stapled sutures. Results obtained by new approaches could be compared with these data.
本研究旨在评估结直肠吻合术传统吻合方式的实际效果。由一个手术团队连续完成的1000例吻合术所收集的信息可被视为可靠的参考数据，新方法的结果可与之进行比较。
1979年至1992年连续进行了1000例吻合术。详细记录了手术过程的特点、术中情况、死亡率、并发症及临床结局。
患者中男性528例，女性472例（年龄范围20至90岁；平均年龄63岁）。82.3%的病例采用装载最大钉仓的圆形吻合器进行吻合。术中发现124例存在缺陷。127例行转流性结肠造口术。术后平均死亡率为2.2%。35例发生临床吻合口漏：低位吻合（距齿状线小于5 cm）后发生率为11.4%，高位吻合后为2.2%。转流性结肠造口术影响极低位吻合患者的漏率。吻合口漏导致的总失败率（死亡、永久性结肠造口）为1.6%。在933例接受随访的幸存者中，不良功能结局的发生率从首次就诊时的10%降至末次就诊时的4.3%。分别有3例和1例患者因症状性狭窄需要经肛门扩张和再次吻合。
结直肠吻合术的传统吻合方式可靠，但需要严格遵守肠道吻合规则并仔细检查吻合缝线。新方法的结果可与这些数据进行比较。
