背景:尽管在结直肠领域使用吻合器进行功能性端到端吻合术(FEEA)已得到全世界的认可,技术因外科医生而异,使用不同技术吻合的安全性尚不清楚。
方法:这项多中心前瞻性观察队列研究由横滨的KYCC研究组进行,Japan,包括2020年4月至2022年3月期间在7个中心接受结肠切除术的患者.这项研究比较了与手术相关的腹部并发症的发生率(SAC:吻合口漏[AL],吻合口出血,腹内脓肿,肠炎,肠梗阻,手术部位感染,和其他腹部并发症)在两种不同的FEEA方法之间(一步[OS]方法:同时吻合和肠切除;两步[TS]方法:肠切除后吻合)。评估Clavien-Dindo分类2级或更高的并发症。
结果:在293个符合条件的案例中,194例(66.2%)和99例(33.8%)患者采用OS和TS方法,分别。两组之间的基线特征相似。操作系统方法使用的订书机较少(三个与四个订书机,p<0.00001)。OS组(19.1%)和TS组(16.2%)之间的SAC率没有显著差异(p=0.44)。OS组有4例(2.1%)AL(2例;3级,2例;2级),而TS组有1例(1.0%)2级AL(p=0.67)。多因素logistic回归分析显示,男性(比值比[OR]3.95;p<0.00001),开放手术入路(OR2.36;p=0.03),和更长的操作持续时间(或,2.79;p=0.002)是并发症的独立预测因子,而OS方法不是独立预测因子(OR1.17;p=0.66)。
结论:在FEEA的结肠吻合术中,OS和TS技术具有相似的术后并发症发生率。
背景:UMIN000039902(注册日期2020年3月23日)。
BACKGROUND: Although functional end-to-end anastomosis (FEEA) using a stapler in the colorectal field has been recognised worldwide, the
technique varies by surgeon, and the safety of anastomosis using different techniques is unknown.
METHODS: This multicentre prospective observational cohort study was conducted by the KYCC Study Group in Yokohama, Japan, and included patients who underwent colonic resection at seven centres between April 2020 and March 2022. This study compared the incidence of surgery-related abdominal complications (SAC: anastomotic leakage [AL], anastomotic bleeding, intra-abdominal abscess, enteritis, ileus, surgical site infection, and other abdominal complications) between two different methods of FEEA (one-step [OS] method: simultaneous anastomosis and bowel resection; two-step [TS] method: anastomosis after bowel resection). Complications of Clavien-Dindo classification grade 2 or higher were assessed.
RESULTS: Among 293 eligible cases, the OS and TS methods were used in 194 (66.2%) and 99 (33.8%) patients, respectively. The baseline characteristics were similar between the groups. The OS method used fewer staplers (three vs. four staplers, p < 0.00001). There were no significant differences in SAC rate between the OS (19.1%) and the TS (16.2%) groups (p = 0.44). The OS group had four cases (2.1%) of AL (two patients; grade 3, two patients; grade 2) while the TS group had one case (1.0%) of grade 2 AL (p = 0.67). Multivariate logistic regression analysis showed that male sex (odds ratio [OR] 3.95; p < 0.00001), an open surgical approach (OR 2.36; p = 0.03), and longer operative duration (OR,2.79; p = 0.002) were independent predictors of complications, whereas the OS method was not an independent predictor (OR 1.17; p = 0.66).
CONCLUSIONS: The OS and the TS
technique for stapled colonic anastomosis in a FEEA had a similar postoperative complication rate.
BACKGROUND: UMIN000039902 (registration date 23 March 2020).