Choi H J, Kim H H, Jung G J, Kim S S
Department of Surgery, Dong-A University College of Medicine, Pusan, South Korea.
Dis Colon Rectum. 1998 Oct;41(10):1281-6. doi: 10.1007/BF02258229.
Although sutureless anastomosis by use of the biofragmentable anastomotic ring is now accepted as an alternative to conventional manual sutured or stapled methods in elective enterocolic surgery, its applicability to emergency enterocolic surgery has not yet been established. The aim of this prospective study was to determine whether the biofragmentable anastomotic ring anastomosis in emergency enterocolic surgery could be performed as safely as in elective surgery or as emergency handsewn anastomosis.
To evaluate the safety and efficacy of sutureless bowel anastomosis by use of the biofragmentable anastomotic ring in emergency enterocolic surgery, a prospective, randomized study was undertaken to compare the biofragmentable anastomotic ring with conventional handsewn anastomotic technique. One hundred nineteen patients who required emergency laparotomy were randomly assigned to two groups: 56 patients (47 percent) underwent 58 biofragmentable anastomotic ring anastomoses, and 63 patients (53 percent) underwent 65 sutured anastomoses. In addition, the safety and efficacy of the biofragmentable anastomotic ring in emergency surgery were compared with those of the biofragmentable anastomotic ring in 86 elective biofragmentable anastomotic ring anastomoses performed in 84 patients during the same period of time.
Specific intraoperative complications related to use of biofragmentable anastomotic rings occurred in six patients (10.7 percent), and another new biofragmentable anastomotic ring anastomosis was constructed in one patient. These reflected learning-curve errors, but they did not adversely affect the outcome. No statistical differences were observed among the groups with respect to wound complications, postoperative bleeding, intra-abdominal abscess, intestinal obstruction, or postoperative death. As for anastomotic leakage, six patients, two in each group, had complications of anastomotic failure, wherein four colonic fistulas required a diversion and two enteric fistulas closed spontaneously. Although there were no statistically significant differences in incidence of leaks among groups (P = 0.4522), two fistulas in colocolic anastomoses, one in the suture group and the other in the biofragmentable anastomotic ring group, manifested the risk of primary anastomosis in emergency colon resection. Seven patients, three in the elective biofragmentable anastomotic ring group and two each in the emergency suture and biofragmentable anastomotic ring groups, died after the operation, but no deaths were directly attributed to the anastomotic technique used.
The data suggest that the biofragmentable anastomotic ring is a safe and reliable alternative to conventional handsewn anastomosis in emergency enterocolic surgery, where the rapidity and security of anastomosis may be critical. Consideration, however, should be given to emergency primary colocolic or colorectal anastomosis, because of a high risk of anastomotic failure, although there are too few cases for a definite conclusion.
尽管在择期结直肠手术中，使用生物可降解吻合环进行无缝合吻合术已被视为传统手工缝合或吻合器吻合方法的替代方案，但其在急诊结直肠手术中的适用性尚未确立。这项前瞻性研究的目的是确定在急诊结直肠手术中，使用生物可降解吻合环进行吻合术是否能与择期手术或急诊手工缝合吻合术一样安全。
为评估在急诊结直肠手术中使用生物可降解吻合环进行无缝合肠吻合术的安全性和有效性，进行了一项前瞻性随机研究，将生物可降解吻合环与传统手工缝合吻合技术进行比较。119例需要急诊剖腹手术的患者被随机分为两组：56例患者（47%）接受了58次生物可降解吻合环吻合术，63例患者（53%）接受了65次缝合吻合术。此外，还将急诊手术中生物可降解吻合环的安全性和有效性与同期84例患者进行的86次择期生物可降解吻合环吻合术的安全性和有效性进行了比较。
6例患者（10.7%）出现了与使用生物可降解吻合环相关的特定术中并发症，1例患者进行了另一次新的生物可降解吻合环吻合术。这些反映了学习曲线误差，但并未对结果产生不利影响。在伤口并发症、术后出血、腹腔内脓肿、肠梗阻或术后死亡方面，各组之间未观察到统计学差异。至于吻合口漏，每组有2例患者共6例出现吻合失败并发症，其中4例结肠瘘需要改道，2例肠瘘自行闭合。尽管各组之间漏的发生率无统计学显著差异（P = 0.4522），但结肠结肠吻合术中的2例瘘，1例在缝合组，另1例在生物可降解吻合环组，显示了急诊结肠切除术中一期吻合的风险。7例患者术后死亡，其中择期生物可降解吻合环组3例，急诊缝合组和生物可降解吻合环组各2例，但没有死亡直接归因于所使用的吻合技术。
数据表明，在急诊结直肠手术中，生物可降解吻合环是传统手工缝合吻合术的一种安全可靠的替代方法，在这种手术中吻合的快速性和安全性可能至关重要。然而，由于吻合失败风险高，应考虑急诊一期结肠结肠或结直肠吻合术，尽管病例数太少，无法得出明确结论。
