Management and outcome of colorectal anastomotic leaks
Management and outcome of colorectal anastomotic leaks
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DOI：
10.1007/s00384-010-1094-3
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发表时间：
2011-03-01
影响因子：
2.8
通讯作者：
Rooney, Paul
中科院分区：
文献类型：
--
作者：
Thornton, Michael;Joshi, Heman;Rooney, Paul
吻合口漏是肠吻合的毁灭性并发症。最优的管理和结果并不是例行公事地描述的，我们的许多知识依赖于历史数据。我们希望研究21世纪结直肠外科手术单元吻合口漏的处理和结果。对2002年1月至2008年12月在一所大型大学教学医院发生的所有结直肠吻合口漏的患者进行回顾性调查。收集的资料包括吻合口漏的患者特征、初步诊断、诊断方式和诊断时间、住院管理、发病率和死亡率、永久性造口率、医院资源使用情况。30例患者(男16例，女14例)，年龄25~84岁，平均60岁。出现临床疑似渗漏的中位时间为12天(范围3-56天)。14例再次手术，10例需要拆除吻合口。平均住院天数为40天。直肠吻合口瘘的永久性吻合口率为27%，结肠吻合口瘘的永久性吻合口率为57.1%。本组患者的总死亡率为27%。结肠吻合口漏的死亡率高于直肠吻合口漏的死亡率(分别为43.8%和7.1%)。吻合口漏直到手术后期才被发现，且与高死亡率相关。对医院资源的需求很高。在本研究中，结肠吻合术后漏的患者死亡率和永久性吻合口率高于直肠吻合术后的患者。
Anastomotic leak is a devastating complication of an intestinal anastomosis. Optimal management and outcome is not routinely described, and much of our knowledge relies upon historical data. We wished to examine the management and outcome of anastomotic leaks on a colorectal surgery unit in the twenty-first century.A retrospective audit of all patients who had a colorectal anastomotic leak between January 2002 and December 2008 in a large university teaching hospital. Data collected included patient characteristics, primary diagnosis, mode of diagnosis and time to diagnosis of anastomotic leak, inpatient management, morbidity and mortality, permanent stoma rate, use of hospital resources.Thirty patients (16 male, 14 female), with a median age of 60 years (range 25-84 years), had an anastomotic leak. The median time to presentation of clinically suspected leaks was 12 days (range 3-56 days). Fourteen patients required reoperation, with ten needing the anastomosis take down. Average hospital stay was 40 days. The permanent stoma rate following a rectal anastomotic leak was 27% and 57.1% from a colonic leak. Overall mortality in this series was 27%. Mortality was higher after leak from a colonic anastomosis than after leak from a rectal anastomosis (43.8% vs. 7.1%, respectively).Anastomotic leaks are not detected until late in the post-operative period and are associated with a high mortality. Demand on hospital resources is high. In this series, patients who leaked after a colonic anastomosis had a higher mortality and permanent stoma rate than after leaks from a rectal anastomosis.