Vignali A, Fazio V W, Lavery I C, Milsom J W, Church J M, Hull T L, Strong S A, Oakley J R
Department of Colorectal Surgery, The Cleveland Clinic Foundation, OH 44195, USA.
J Am Coll Surg. 1997 Aug;185(2):105-13. doi: 10.1016/s1072-7515(97)00018-5.
Despite improvement in surgical techniques and stapling devices during the last 10 years, colorectal anastomoses are still prone to leakage. The purpose of this study was to assess the performance and safety of stapled anastomoses in rectal surgery and to identify factors that influence the occurrence of anastomotic leaks.
A review was undertaken of 1,014 patients who underwent stapled anastomoses to the rectum or anal canal for colorectal cancer or benign disease between 1989 and 1995 in a tertiary care institution. Indications for operations, comorbidities at admission, preoperative bowel preparation, stapler size, intraoperative events, associated surgical procedures, and clinical outcomes were tested for any association with anastomotic leak.
A double stapled technique was used in 154 patients and a conventional single stapler technique was used in 860. Postoperative mortality was 1.6%, and the overall morbidity was 18.4%. Clinically apparent anastomotic leak developed in 29 patients (2.9%). Anastomotic dehiscence occurred in 22 of 284 patients (7.7%) after low stapling (within 7 cm from the anal verge) and in 7 of 730 patients (1%) after high stapling (p < 0.001). Diabetes mellitus, use of pelvic drainage, and duration of surgery were significantly related to the occurrence of anastomotic leak by the univariate analysis. Multivariate regression analysis identified an anastomotic distance from the anal verge within 7 cm as the only variable related to the occurrence of postoperative leak (p < 0.001).
Low anastomoses were associated with a leak rate greater than with high colorectal anastomoses. We conclude that anastomoses to the rectum using the circular stapler can be done with low mortality and morbidity.
尽管在过去10年里手术技术和吻合器设备有所改进，但结直肠吻合口仍易于发生渗漏。本研究的目的是评估直肠手术中吻合器吻合的性能和安全性，并确定影响吻合口漏发生的因素。
对1989年至1995年在一家三级医疗机构因结直肠癌或良性疾病接受直肠或肛管吻合器吻合术的1014例患者进行了回顾性研究。对手术指征、入院时的合并症、术前肠道准备、吻合器尺寸、术中情况、相关手术操作以及临床结果进行检测，以确定其与吻合口漏的任何关联。
154例患者采用双吻合器技术，860例采用传统单吻合器技术。术后死亡率为1.6%，总体发病率为18.4%。29例患者（2.9%）出现临床明显的吻合口漏。低位吻合（距肛缘7 cm以内）的284例患者中有22例（7.7%）发生吻合口裂开，高位吻合（距肛缘7 cm以上）的730例患者中有7例（1%）发生吻合口裂开（p<0.001）。单因素分析显示，糖尿病、盆腔引流的使用以及手术时间与吻合口漏的发生显著相关。多因素回归分析确定距肛缘7 cm以内的吻合距离是与术后漏发生相关的唯一变量（p<0.001）。
低位吻合的漏率高于高位结直肠吻合。我们得出结论，使用圆形吻合器进行直肠吻合可以实现较低的死亡率和发病率。
