Delayed endoluminal vacuum therapy for rectal anastomotic leaks after rectal resection in a swine model: a new treatment option.
Delayed endoluminal vacuum therapy for rectal anastomotic leaks after rectal resection in a swine model: a new treatment option.
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猪模型直肠切除术后直肠吻合口漏的延迟腔内真空治疗：一种新的治疗选择。
DOI：
10.1111/cts.12140
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Kleiner,DanielE
中科院分区：
文献类型：
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作者：
Rosenberger,LauraH;Shada,Amber;Ritter,LaneA;Mauro,DavidM;Mentrikoski,MarkJ;Feldman,SanfordH;Kleiner,DanielE
吻合口漏是结直肠手术后一种可怕的手术并发症。临时近端回肠造口用于高风险结肠炎，但是，其创建和逆转会累积额外的手术风险。在猪模型中，腔内真空治疗已被证明可在预防性环境中密封吻合口缺损，我们假设其可延迟用于抢救活动性吻合口瘘受试者。对约克郡猪进行直肠切除术，通过荧光镜检查确认故意泄漏，并将腔内真空治疗装置放置至低持续抽吸。处理后，进行造影剂灌肠和尸检，以进行大体和组织病理学检查。猪在器械放置前经历2（或5）天的自由腹膜内泄漏，随后进行5（或7）天的腔内真空治疗。7头早期处理猪中有6头闭合了其吻合口缺损，而该扩展组中4头处理猪中有2头闭合了缺损。腔内真空治疗在猪模型中是可行的且耐受性良好，并且已显示其在早期密封大量自由渗漏的血栓（86%）。这项技术值得进一步研究，因为它可能提供一种治疗吻合口漏的无创方法。
Anastomotic leaks are a dreaded surgical complication following colorectal operations. Creation of a temporary proximal diverting ileostomy is used in high‐risk anastomoses, however, additional surgical risk is accumulated with its creation and reversal. Endoluminal vacuum therapy has been shown to seal anastomotic defects in the prophylactic setting in a pig model and we hypothesized it could be utilized in a delayed fashion to rescue subjects with an active anastomotic leak. Yorkshire pigs underwent rectal resection, intentional leak confirmed by fluoroscopy, and endoluminal vacuum therapy device placement to low continuous suction. Following treatment, a contrast enema and necropsy was performed for gross and histopathology. Pigs underwent 2 (or 5) days of free intraperitoneal leak prior to device placement and 5 (or 7) subsequent days of endoluminal vacuum therapy. Six of seven early‐treated pigs sealed their anastomotic defect, while two of the four treated pigs in this extended group sealed the defect. Endoluminal vacuum therapy is feasible and well tolerated in a pig model, and it has been shown to seal a significant number of freely leaking anastomoses in the early period (86%). This technology warrants further study as it may provide a noninvasive means to treatment of anastomotic leaks.