背景:吻合口狭窄(AS)是结直肠切除术后常见的并发症。然而,狭窄形成的诱发因素尚未完全了解。先前的研究表明吻合口漏(AL)是AS发生的危险因素。因此,目的探讨结直肠切除术后吻合口瘘的特点对吻合口狭窄发生的影响。
方法:连续选择AL患者,括约肌保存,结直肠切除术,不管有没有分流造口术,从前瞻性收集的数据库中确定了2009年1月至2023年3月之间的数据.吻合口漏的特点,采用单因素和多因素logistic回归分析患者基线和手术特征以及术后结局,以确定与AS术后渗漏发生相关的因素.
结果:共有129例患者发展为AL并符合纳入标准。其中,28例(21.7%)患者被诊断为渗漏后AS。AS组患者接受新辅助放疗(18%vs3%;p=0.026)和手工缝合吻合(39%vs17%;p=0.011)的频率明显更高。此外,AS组吻合口缺损程度明显高于非AS组(50%,IQR27-71vs.20%,IQR9-40,p=0.011)。在年龄方面,研究组之间观察到类似的发现,性别,BMI,ASA得分,医疗合并症,诊断,外科手术,手术入路(开放与微创),和吻合方式(侧端与端到端)。在多变量分析中,吻合口缺损程度(OR1.01;95%CI1.00-1.03;p=0.034)和手工缝合吻合(OR2.68;95%CI1.01-6.98;p=0.043)被证实是AS术后渗漏的独立危险因素。未观察到泄漏后AS的发生与AL的ISREC分级之间的相关性,吻合口高度或AL的管理。AS组的造口术逆转时间明显更长(202d,IQR169-275vs.318dIQR192-416,p=0.014)。
结论:吻合口缺损程度和手缝吻合是发生AS后渗漏的独立危险因素。AL的ISREC分级之间没有相关性,吻合口高度或AL管理,以及后泄漏AS的发生。
BACKGROUND: Anastomotic stenosis (AS) is a common complication after colorectal resection. However, the predisposing factors for stricture formation are not fully understood. Previous studies have shown anastomotic leakage (AL) to be a risk factor for the occurrence of AS. Therefore, we aim to investigate the impact of anastomotic leakage characteristics on the occurrence of anastomotic stenosis after colorectal resection.
METHODS: Consecutive patients with AL following elective, sphincter preserving, colorectal resection, with or without diversion ostomy, between January 2009 and March 2023 were identified from a prospectively collected database. The characteristics of the anastomotic leakage, patient baseline and operative characteristics as well as the postoperative outcomes were analyzed using univariate and multivariate logistic regression to identify factors associated with the occurrence of post-leakage AS.
RESULTS: A total of 129 patients developed AL and met the inclusion criteria. Among these, 28 (21.7%) patients were diagnosed with post-leakage AS. There was a significantly higher frequency of patients with neoadjuvant radiotherapy (18% vs 3%; p = .026) and hand-sewn anastomoses (39% vs 17%; p = .011) within the AS group. Furthermore, the extent of the anastomotic defect was significantly higher in the AS group compared with the non-AS group (50%, IQR 27-71 vs. 20%, IQR 9-40, p = 0.011). Similar findings were observed between the study groups regarding age, sex, BMI, ASA score, medical comorbidities, diagnosis, surgical procedure, surgical approach (open vs. minimally invasive), and anastomotic fashioning (side-to-end vs. end-to-end). On multivariate analysis, the extent of the anastomotic defect (OR 1.01; 95% CI 1.00-1.03; p = 0.034) and hand-sewn anastomoses (OR 2.68; 95% CI 1.01-6.98; p = 0.043) were confirmed as independent risk factors for post-leakage AS. No correlation could be observed between the occurrence of post-leakage AS and the ISREC grading of AL, the anastomotic height or the management of AL. Time to ostomy reversal was significantly longer in the AS group (202d, IQR 169-275 vs. 318d IQR 192-416, p = 0.014).
CONCLUSIONS: The extent of the anastomotic defect and hand-sewn anastomoses were confirmed as independent risk factors for the occurrence of post-leakage AS. No correlation could be observed between the ISREC grading of AL, the anastomotic height or AL management, and the occurrence of post-leakage AS.