Endoscopic evaluation of clinical colorectal anastomotic leakage
Endoscopic evaluation of clinical colorectal anastomotic leakage
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DOI：
10.1016/j.jss.2014.07.009
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发表时间：
2015-01-01
影响因子：
2.2
通讯作者：
Maehara, Yoshihiko
中科院分区：
文献类型：
--
作者：
Ikeda, Tetsuo;Kumashiro, Ryuichi;Maehara, Yoshihiko
背景：吻合口漏（AL）是前切除术后的主要并发症。然而，其治疗策略和技术风险因素尚未得到很好的确立。因此，我们在内镜下评估吻合区域后，腹腔镜结直肠吻合术使用双吻合技术（DST）的治疗和调查的technical factors.Methods的确定：在总共191例连续患者进行了腹腔镜前切除术与DST从2008年9月至2013年1月。结果：19例患者吻合口裂开，18例（9.3%）诊断为AL。在19例患者中，12例通过建立肠造口进行治疗，7例根据其临床状况和内窥镜检查结果进行保守治疗。在19个吻合区域中观察到23处开裂;所有23处开裂均发生在圆形吻合器吻合线上。在这23例裂开中，13例（56.5%）位于圆形吻合器和直线吻合器吻合线重叠的位置，10例（43.5%）位于重叠点之间的圆周方向。结论：吻合部位的内镜评价是安全的，可用于确定治疗策略。DST吻合技术本身可能与AL的发展密切相关。（C）2015 Elsevier Inc. All rights reserved.
Background: Anastomotic leakage (AL) is a major complication after anterior resection. However, its therapeutic strategies and technical risk factors have not been well established. Therefore, we endoscopically evaluated anastomotic regions after laparoscopic colorectal anastomosis using a double-stapling technique (DST) for determination of treatment and investigation of technical factors.Methods: In total, 191 consecutive patients underwent laparoscopic anterior resection with a DST from September 2008-January 2013. Anastomotic regions were endoscopically evaluated in patients suspected to have AL after surgery.Results: Anastomotic dehiscence was observed in 19 patients, and AL was diagnosed in 18 (9.3%). Of the 19 patients, 12 were treated by creation of an intestinal stoma and 7 were treated conservatively based on their clinical status and endoscopic findings. Twenty-three dehiscences were observed among 19 anastomotic regions; all 23 were observed on the circular stapler anastomosis lines. Of these 23 dehiscences, 13 (56.5%) were located at the point at which the anastomosis lines of the circular and linear staplers overlapped, and 10 (43.5%) were located on the circumferential aspect between the overlapping points.Conclusions: Endoscopic evaluation of anastomotic regions is safe and useful for the determination of therapeutic strategies. The DST anastomotic technique itself may be closely related to the development of AL. (C) 2015 Elsevier Inc. All rights reserved.