Pakkastie T E, Luukkonen P E, Järvinen H J
Second Department of Surgery, Helsinki University Central Hospital, Finland.
Eur J Surg. 1994 May;160(5):293-7; discussion 299-300.
To evaluate the results of elective colorectal operations, to identify factors that influence the anastomotic leak rate, and to assess the value of a covering colostomy.
Retrospective study.
University hospital.
134 consecutive patients undergoing elective resection for a neoplasm (125 carcinomas and 10 villous adenomas) of the colon and rectum.
135 operations (one for a recurrence in the anastomotic line).
Morbidity and mortality.
Two patients died (1%) and there were 29 complications (21%); 16 patients developed clinical anastomotic leaks (12%) and 3 patients symptomatic strictures (2%). One patient who developed a leak died and 11 of the 16 (69%) were re-operated on. The rest settled spontaneously. The only significant risk factor associated with leakage was distance of the anastomosis from the anal verge (all 16 leaks were within 7 cm, compared with 44/118 without leaks, p < 0.001). Four patients who developed leaks were left with permanent colostomies. Protecting stomas had no significant influence, despite the fact that only 1 of those that developed leaks had a colostomy compared with 9/109 that did not.
Prospective controlled studies are needed to establish the true value of a covering colostomy after low colorectal anastomosis.
评估择期结直肠手术的结果，确定影响吻合口漏发生率的因素，并评估预防性结肠造口术的价值。
回顾性研究。
大学医院。
134例因结肠和直肠肿瘤（125例癌和10例绒毛状腺瘤）接受择期切除术的连续患者。
135例手术（1例为吻合口复发手术）。
发病率和死亡率。
2例患者死亡（1%），发生29例并发症（21%）；16例患者出现临床吻合口漏（12%），3例出现症状性狭窄（2%）。1例发生吻合口漏的患者死亡，16例中的11例（69%）接受了再次手术。其余患者自行痊愈。与吻合口漏相关的唯一显著危险因素是吻合口距肛缘的距离（所有16例漏均发生在距肛缘7 cm以内，而无漏的118例中为44例，p<0.0）。4例发生吻合口漏的患者留置了永久性结肠造口。尽管发生吻合口漏的患者中只有1例有结肠造口，而未发生漏的109例中有9例有结肠造口，但预防性结肠造口术并无显著影响。
需要进行前瞻性对照研究以确定低位结直肠吻合术后预防性结肠造口术的真正价值。
