Ordorica-Flores R M, Bracho-Blanchet E, Nieto-Zermeño J, Reyes-Retana R, Tovilla-Mercado J M, Leon-Villanueva V, Varela-Fascinetto G
Department of Pediatric Surgery, Hospital Infantil de Mexico Federico Gómez, Universidad Nacional Autónoma de México, México City.
J Pediatr Surg. 1998 Dec;33(12):1757-9. doi: 10.1016/s0022-3468(98)90279-2.
The aim of this study was to compare the incidence of surgical complications between two different surgical techniques for intestinal anastomosis in children.
This was a clinically controlled, randomized study with blind follow-up from 18 to 36 months performed at the Reference Government Hospital in Mexico City. Eighty-six children required intestinal anastomosis, ages ranged between 1 month and 16 years, with emergency or elective surgery. Anastomoses of duodenum, rectum, with enteroplasty or protected with a proximal stoma were excluded. Two randomized groups were formed: (1) anastomosis with one layer of suture (Gambee stitches) and (2) with two layers of suture (first with Connel-Mayo stitches then with Lembert). Both groups were controlled in the principal variables without differences, and the follow-up concerning postoperative recovery was blind for the surgical team.
Forty-two cases in group 1 and 44 in group 2 were compared. Intestinal dehiscence was found in 5 of 86 (5.8%), two from group I and three from group II (P value, not significant). Surgical time for anastomosis with one layer was an average of 26 minutes versus 43 minutes with two layers (P<.001). There were no stenoses within the follow-up period.
This study proves that intestinal anastomosis with one layer of suture is as safe as anastomosis with two layers in children, and the time spent for completion of the procedure is significantly less with one plane of suture. For those reasons, it is the method of choice for intestinal anastomosis in children.
本研究旨在比较两种不同小儿肠吻合手术技术的手术并发症发生率。
这是一项在墨西哥城参考政府医院进行的临床对照随机研究，进行了18至36个月的盲法随访。86名儿童需要进行肠吻合术，年龄在1个月至16岁之间，接受急诊或择期手术。十二指肠、直肠吻合术，伴有肠成形术或近端造口保护的病例被排除。形成了两个随机组：（1）单层缝合吻合术（甘比缝合法）和（2）双层缝合吻合术（先用康奈尔-梅奥缝合法，然后用伦伯特缝合法）。两组在主要变量上得到控制且无差异，手术团队对术后恢复情况的随访是盲法进行的。
比较了第1组的42例和第2组的44例。86例中有5例（5.8%）发生肠裂开，其中第1组2例，第2组3例（P值，无统计学意义）。单层吻合术的手术时间平均为26分钟，而双层吻合术为43分钟（P<0.001）。随访期间无狭窄发生。
本研究证明，小儿单层缝合肠吻合术与双层缝合吻合术一样安全，且单层缝合完成手术的时间明显更短。基于这些原因，它是小儿肠吻合术的首选方法。
