Karanjia N D, Corder A P, Bearn P, Heald R J
Colorectal Research Unit, Basingstoke District Hospital, UK.
Br J Surg. 1994 Aug;81(8):1224-6. doi: 10.1002/bjs.1800810850.
Over 14 years 276 patients with rectal cancer underwent surgery; 219 who underwent low anterior resection of the rectum with total mesorectal excision were studied. There were 24 (11.0 per cent) major anastomotic leaks associated with peritonitis or a pelvic collection and 14 (6.4 per cent) minor leaks that were asymptomatic and detected by contrast enema. All major leaks occurred at an anastomotic height of less than 6 cm (P = 0.08). The abdominoperineal excision rate was 9.1 per cent. Major leaks were associated with failure to defunction in 11 of 62 patients and with a defunctioning colostomy in 13 of 157 (P = 0.03). Of the 24 patients with major leaks seven developed peritonitis, one with a defunctioned anastomosis (P = 0.002), and three died (P = 0.02). Use of the sigmoid colon led to major leakage in seven of 32 patients compared with 17 of 187 when the splenic flexure was employed (P = 0.05). There was no increase in the local recurrence rate but only nine patients with major leakage and a temporary stoma have had these closed. Key technical factors include: a clean dry pelvic cavity, pulsatile colonic blood supply, suction drainage started during closure and mobilization of ample tissue to fill the pelvic space.
在14年期间，276例直肠癌患者接受了手术；对219例行直肠低位前切除术并完整系膜切除的患者进行了研究。有24例（11.0%）发生了与腹膜炎或盆腔积液相关的严重吻合口漏，14例（6.4%）为无症状的轻微漏，通过造影灌肠检测到。所有严重漏均发生在吻合口高度小于6 cm处（P = 0.08）。腹会阴联合切除术的比例为9.1%。严重漏与62例患者中的11例未行肠造口减压及157例中的13例行肠造口减压有关（P = 0.03）。在24例发生严重漏的患者中，7例发生了腹膜炎，其中1例为已行肠造口减压的吻合口漏（P = 0.002），3例死亡（P = 0.02）。使用乙状结肠导致32例患者中的7例发生严重漏，而使用脾曲时187例中有17例发生严重漏（P = 0.05）。局部复发率没有增加，但只有9例发生严重漏且有临时造口的患者关闭了造口。关键技术因素包括：盆腔清洁干燥、结肠血供有搏动、关闭时开始进行负压引流以及游离足够的组织以填充盆腔间隙。
