Effectiveness of endosponge therapy for the management of presacral abscesses following rectal surgery
Effectiveness of endosponge therapy for the management of presacral abscesses following rectal surgery
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DOI：
10.1007/s10151-019-02007-9
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发表时间：
2019-06-01
影响因子：
3.3
通讯作者：
Vermaas, M.
中科院分区：
文献类型：
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作者：
Huisman, J. F.;van Westreenen, H. L.;Vermaas, M.
直肠手术后吻合口漏的报告率为9%（范围3-28%）。我们研究的目的是评价吻合口海绵治疗的有效性。终点是吻合口漏后的连续性恢复率和功能性肠结局。方法本研究为多中心回顾性队列研究。纳入了2012年1月至2017年8月期间接受内镜海绵治疗的所有直肠手术后症状性吻合口瘘患者。使用低位前切除综合征（LARS）评分系统测量功能性肠结局。结果20例患者入选。18例患者（90%）因直肠癌行低位前切除术。14例患者（70%）在初次手术干预时进行了回肠造口术。14例患者（70%）接受了新辅助（化疗）放疗。初次手术干预与首次置入海绵体之间的中位时间为21（5-537）天。海绵体内变化的中位数为9（2-28）。海绵体治疗的成功率为88%，恢复胃肠连续性的成功率为73%。3例患者（15%）发生慢性鼻窦炎。所有患者均发生LARS，其中77%报告了严重LARS。结论内镜海绵治疗骶前腔闭合成功率高，73%的患者术后胃肠功能恢复正常。然而，尽管进行了海绵体内治疗，许多患者仍发生了严重的LARS。
Background Anastomotic leak after rectal surgery is reported in 9% (range 3-28%) of patients. The aim of our study was to evaluate the effectiveness of endosponge therapy for anastomotic. Endpoints were the rate of restored continuity and the functional bowel outcome after anastomotic leakage. Methods This was a multicenter retrospective observational cohort study. All patients with symptomatic anastomotic leakage after rectal surgery who had endosponge therapy between January 2012 and August 2017 were included. Functional bowel outcome was measured using the low anterior resection syndrome (LARS) score system. Results Twenty patients were included. Eighteen patients had low anterior resection (90%) for rectal cancer. A diverting ileostomy was performed at primary surgical intervention in 14 patients (70%). Fourteen patients (70%) were treated with neoadjuvant (chemo-)radiotherapy. The median time between primary surgical intervention and first endosponge placement was 21 (5-537) days. The median number of endosponge changes was 9 (2-28). The success rate of the endosponge treatment was 88% and the restored gastrointestinal continuity rate was 73%. A chronic sinus occurred in three patients (15%). All patients developed LARS, of which 77% reported major LARS. Conclusions Endosponge therapy is an effective treatment for the closure of presacral cavities with high success rate and leading to restored gastrointestinal continuity in 73%. However, despite endosponge therapy many patients develop major LARS.