Docherty J G, McGregor J R, Akyol A M, Murray G D, Galloway D J
Department of Surgical Gastroenterology, Gartnavel General Hospital, Glasgow, Scotland, United Kingdom.
Ann Surg. 1995 Feb;221(2):176-84. doi: 10.1097/00000658-199502000-00008.
The authors compared both the initial and the long-term outcomes of patients undergoing stapled and sutured colorectal anastomoses.
Sutured and stapled large bowel anastomoses are perceived to be equally safe, but concern has been raised about increased rates of tumor recurrence with the use of stapling instruments.
The outcome of patients with sutured and stapled colorectal anastomoses were compared in a prospective, multicenter, randomized study. Factors affecting long-term outcomes were assessed by both univariate and multivariate analysis.
Seven hundred thirty-two patients were recruited. There was a significant increase in radiologic leakage in the sutured group (14.4% vs. 5.2%, p < 0.05), but there was no difference in clinical anastomotic leak rates, morbidity, or postoperative mortality. Tumor recurrence and cancer-specific mortality were higher in the sutured patients (7.5% and 6.7%, respectively) and in patients with anastomotic leaks.
This study shows that suturing or stapling are equally safe in large bowel surgery. However, it also shows a long-term benefit of stapling in colorectal cancer patients.
作者比较了接受吻合器和缝线结直肠吻合术患者的初始和长期结局。
缝线和吻合器大肠吻合术被认为同样安全，但有人担心使用吻合器会增加肿瘤复发率。
在一项前瞻性、多中心、随机研究中比较了接受缝线和吻合器结直肠吻合术患者的结局。通过单因素和多因素分析评估影响长期结局的因素。
招募了732例患者。缝线组的影像学渗漏显著增加（14.4%对5.2%，p<0.05），但临床吻合口漏率、发病率或术后死亡率无差异。缝线吻合患者（分别为7.5%和6.7%）以及有吻合口漏的患者的肿瘤复发率和癌症特异性死亡率更高。
本研究表明，在大肠手术中，缝线或吻合器同样安全。然而，它也显示了吻合器在结直肠癌患者中的长期益处。
