INTRAOPERATIVE AIR TESTING OF COLORECTAL ANASTOMOSES - A PROSPECTIVE, RANDOMIZED TRIAL
INTRAOPERATIVE AIR TESTING OF COLORECTAL ANASTOMOSES - A PROSPECTIVE, RANDOMIZED TRIAL
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DOI：
10.1002/bjs.1800771006
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发表时间：
1990-10-01
影响因子：
9.6
通讯作者：
EVERSON, NW
中科院分区：
文献类型：
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作者：
BEARD, JD;NICHOLSON, ML;EVERSON, NW
共145例接受结直肠吻合术的连续患者在吻合术完成后随机分为“试验”组和“无试验”组。在骨盆充满生理盐水和直肠通过乙状结肠镜充气扩张的情况下进行吻合试验。对任何泄漏进行了缝合。术后第10天进行水溶性造影剂灌肠。74名患者被随机分配到“测试”组，71名患者被随机分配到“无测试”组，但每组各有1名患者退出，共留下143名患者进行分析。两组在年龄、性别、诊断和手术细节方面匹配良好。在“测试”组中发现并修复了18处（25%）漏气。术后，“试验”组有3例（4%）临床渗漏，“非试验”组有10例（14%）临床渗漏（Fisher精确检验，P = 0.043）。“测试”组有8例（11%）放射性泄漏，“未测试”组有20例（29%）（P = 0.006）。术中空气检测和结直肠癌修补术可显著降低术后临床和放射性泄漏的风险。
A total of 145 consecutive patients receiving a colorectal anastomosis were randomized to ‘test’ or ‘no test’ once the anastomosis had been completed. Anastomotic testing was performed with the pelvis filled with saline and the rectum distended by sigmoidoscopic insufflation of air. Any leaks demonstrated were oversewn. A water-soluble contrast enema was performed on the tenth postoperative day. Seventy-four patients were randomized to ‘test’ and 71 to ‘no test’ but one patient was withdrawn from each group leaving a total of 143 for analysis. The two groups were well matched for age, sex, diagnosis and operative details. Eighteen (25 per cent) air leaks were detected and repaired in the ‘test’ group. After operation there were three (4 per cent) clinical leaks in the ‘test’ group and ten (14 per cent) in the ‘no test’ group (Fisher's exact test, P = 0.043). There were eight (11 per cent) radiological leaks in the ‘test’ group and 20 (29 per cent) in the ‘no test’ group (P = 0.006). Intraoperative air testing and repair of colorectal anastomoses significantly reduces the risk of postoperative clinical and radiological leaks.