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1.
Prospective evaluation of omentoplasty in preventing leakage of colorectal anastomosis 总被引:11,自引:2,他引:9
Tocchi A Mazzoni G Lepre L Costa G Liotta G Agostini N Miccini M 《Diseases of the colon and rectum》2000,43(7):951-955
PURPOSE: The aim of this study was to investigate the role of omentoplasty, by means of intact omentum, in preventing anastomotic leakages after rectal resection. METHODS: Between 1992 and 1997 a total of 112 patients (64 males) with a mean age of 64.7 (range, 39–83) years were randomly assigned to undergo omentoplasty (Group A) or not (Group B) to reinforce the colorectal anastomosis after anterior resection for rectal cancer. The primary end point was anastomotic leakage; the secondary end point included morbility and mortality related to omentoplasty. RESULTS: The two groups were comparable in terms of preoperative and intraoperative characteristics. Staple-ring disruption at plain abdominal radiographs was detected in seven instances in Group A and in ten in Group B patients (P = not significant). Two leakages were evident clinically in Group A and seven in Group B (P<0.05). Three leaks were documented radiologically in Group A and eight in Group B (P = not significant). No complications related to omentoplasty were observed in Group A. There were two repeat operations for anastomotic leakage in Group B. At follow-up, one stricture developed in Group A and three in Group B (P = not significant) CONCLUSIONS: Despite a similar incidence of staple-ring defects, a strikingly lower rate of clinically and radiologically detected leaks developed in patients submitted to omentoplasty. Although not affecting the incidence of anastomotic disruption, omentoplasty seems to contain the severity of anastomotic leakage. 相似文献
2.
Hao XY Yang KH Guo TK Ma B Tian JH Li HL 《International journal of colorectal disease》2008,23(12):1159-1165
Purpose Whether omentoplasty after colorectal anastomosis can reduce anastomotic leakage is controversial. Our aim was to do a meta-analysis
of randomized controlled trials to compare anastomotic leakage rates between an omentoplasty group and a no omentoplasty group
after colorectal anastomosis.
Materials and methods We searched the Cochrane Center Register of Controlled Trials, PubMed, EMBASE, and Chinese Biomedical Literature Database
up to June 2008 in any language. Reference lists from all selected articles were also examined. Randomized controlled trials
of omentoplasty in the prevention of anastomotic leakage after colorectal resection were selected and evaluated by two investigators.
Analyses were performed using Review Manager 4.2.
Results Three randomized controlled trials totaling 943 participants were included. Meta-analysis results showed that no statistically
significant difference was found between the omentoplasty group and the no omentoplasty group in radiological anastomotic
leakage (RR 0.76, 95% CI 0.41 to 1.40), death (RR 1.01, 95% CI 0.55 to 1.86), and repeat operation (RR 0.60, 95% CI 0.35 to
1.05), except for clinical anastomotic leakage (RR 0.36, 95% CI 0.16 to 0.78).
Conclusion Based on available data from a small number of trials, there is not enough evidence to say whether or not omentoplasty should
be used to reduce anastomotic leakage after colorectal resection. The decision as to whether we should continue to use this
technique might remain a matter of surgical judgment. Therefore, the results still need to be confirmed by future multicenter,
well-designed trials.
Specific author contributions: Tian-Kang Guo, Xiang-Yong Hao and Hong-Ling Li drafted the review and performed the statistical
analyses. Ke-Hu Yang and Jin-Hui Tian wrote the search strategy and performed the electronic searches. Ke-Hu Yang and Bin
Ma extracted data. All authors participated in the interpretation of the statistical analyses, revision of this article, and
approval of the final version submitted. 相似文献
3.
Omentoplasty versus no omentoplasty for cervical esophagogastrostomy following radical esophagectomy 总被引:2,自引:0,他引:2
Ohwada S Ogawa T Kawate S Koyama T Yamada T Yoshimura S Sato Y Tomizawa N Ohya T Morishita Y 《Hepato-gastroenterology》2002,49(43):181-184
BACKGROUND/AIMS: Omentoplasty--wrapping the omentum around the alimentary tract anastomosis is thought to lower the rate of anastomotic leakage. We evaluated the role of omentoplasty to reinforce cervical esophagogastrostomy after radical esophagectomy. METHODOLOGY: We compared anastomotic leakage, stricture formation, and related deaths in 63 patients who underwent radical esophagectomy and cervical esophagogastrostomy, with (n = 48) or without (n = 15) omentoplasty, between 1995 and 1999. RESULTS: An esophageal anastomotic leakage was diagnosed in 1 of the 48 patients (2.1%) with omentoplasty versus 3 of the 15 patients (20.0%) without omentoplasty (P < 0.01). Anastomotic stricture occurred in 2 (4.2%) of the omentoplasty group and 1 (6.7%) of the no omentoplasty group (P < 0.01). Death within 1 month was zero in the omentoplasty group and one (6.7%) in the no-omentoplasty group, despite no differences in lethal anastomotic leakage. CONCLUSIONS: Omentoplasty of cervical esophagogastrostomy reduced anastomotic leakage. Although promising, these observations require confirmation with a randomized prospective study. 相似文献
4.
目的通过比较放置吻合口支架与单纯手工缝合对大鼠结肠吻合口漏的影响,探索吻合口支架对降低结肠术后吻合口漏发生率的应用价值。
方法以32只雄性SD大鼠为研究对象,随机分为2组,每组16只,行大鼠结肠端端吻合术,实验组行间断缝合的同时放置支架,即支架组;对照组单纯行间断缝合,即手工缝合组。比较两组腹腔粘连程度、吻合口漏、总生存率的差异。
结果相对于手工缝合组,支架组吻合腹腔粘连程度评分较低(5.94±1.69 vs. 9.19±2.52,t=4.181;P=0.008);支架组吻合口漏发生率明显低于手工缝合组(12.5% vs. 56.25%,χ2=6.788;P=0.023);支架组总生存率高于手工缝合组(87.5% vs. 43.75%,χ2=5.850;P=0.016)。
结论相对于手工缝合,吻合口支架可以减少大鼠术后腹腔粘连程度,降低吻合口漏发生率,具有潜在临床应用价值。 相似文献
5.
目的 探讨内镜下大肠支架置入在老年人结直肠癌并急性肠梗阻的临床应用价值.方法 65岁以上结直肠癌并急性肠梗阻患者82例,分为大肠支架组41例,行Niti-S肠道支架置入;以及急诊手术组41例,根据术中探查结果分别行肿瘤切除及结肠造瘘.比较两组的平均住院日,平均住院费用,中位生存时间,1年生存率,围手术期病死率,手术并发症等情况.结果 大肠支架组平均住院日(17.9±6.7)d,平均住院费用40 047元,中位生存时间(9.4±4.4)个月,1年生存率43.9%.急诊手术组平均住院日(24.4±4.6)d,平均住院费用61 867元,中位生存时间(8.8±4.8)个月,1年生存率36.6%.结论 大肠内支架对于结直肠癌合并肠梗阻的老年患者是一种安全、经济、有效的治疗方式.Abstract: Objective To evaluate the clinica1 value of endoscopic placement of colorectal metal stents for malignant colonic obstruction in aged patients. Methods The 82 cases who were older than 65 years with malignant colonic obstruction were randomly divided into colorectal metal stenting group who were treated with endoscopic Niti-S colorectal metal stenting and emergency surgery group who were treated with tumor resection or colostomy. The average length of stay, average hospitalization charge, median survival time, one-year survival rate, perioperative mortality, and the complications such as anastomotic leakage, incision infection were analyzed. Results In colorectal metal stenting group, in 39 of 41 patients, metal stents were successfully inserted, without complications of hemorrhage, perforation and so on. And the symptoms of obstruction were effectively relieved within 2 days. The 17 cases underwent subsequent elective radical resection of colorectal carcinoma after 1 week, without complications of anastomotic leakage. The 22 cases were treated with colorectal metal stenting for palliative treatment. There were 4 cases of stent migration and 5 cases of stent obstruction again. The average length of inhospital stay was (17.9±6.7) days, the average hospitalization charge was 40 047 yuan, the median survival time was (9.4±4.4) months, and one-year survival rate was 43.9%. In emergency surgery group, 13 cases underwent tumor resection and 28 cases received colostomy. The 14 cases presented with multiple organ dysfunction, 8 cases died preoperatively, 4 cases presented with anastigmatic leakage. The average length of stay was (24.4±4.6) day, the average hospitalization charge was 61 867 yuan, the median survival time was (8.8±4.8) months, and one-year survival rate was 36.6%. Conclusions Endoscopic colorectal metal stenting is a safe, economic and effective treatment for malignant colonic obstruction in aged patients, especially reduces the risk of surgical complications, improves the aged patient's quality of life. 相似文献
6.
Anastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer 总被引:16,自引:2,他引:16
S. Petersen M. Freitag G. Hellmich K. Ludwig 《International journal of colorectal disease》1998,13(4):160-163
Anastomotic leakage is a serious complication in colorectal surgery, especially in the treatment of adenocarcinoma located
in the left-sided colon and rectum. It is controversial whether anastomotic leakage is a prognostic factor for local recurrence
and/or survival in this disease. To evaluate the impact of anastomotic dehiscence on the outcome of surgery we reviewed data
on 467 consecutive patients with adenocarcinoma of the left colon and rectum treated between 1985 and 1995 in our Department.
Of these, 41 (8.8%) developed anastomotic leakage. The overall-survival differed nonsignificantly (P=0.57) between leakage and nonleakage groups. Of 331 patients with curative resection 29 showed an anastomotic leakage. There
were 46 R0-resected patients who died under disease-related conditions: 7 patients in the leakage group (24.1%) and 39 in
the nonleakage group (12.9%; P=0.045). In the curatively resected group 5 of 29 patients developed local recurrence in the leakage group (17.2%) but only
26 of 302 patients in the nonleakage group (8.6%; P = 0.0357). Multivariate analysis showed only the factors of age, stage of resection, staging of lymph nodes, and tumor staging
as independent prognostic factors for overall survival. For local recurrence the multivariate analysis revealed tumor staging
and anastomotic leakage as independently significant. Anastomotic leakage thus appears to be a prognostic factor for local
tumor recurrence of colorectal cancer. In addition, disease-related survival is considerably decreased under leakage conditions.
Anastomotic leakage was not shown in this study to be an independent prognostic factor for overall survival due to the lack
of statistical significance.
Accepted: 20 July 1998 相似文献
7.
Value of a protective stoma in low anterior resections for rectal cancer 总被引:19,自引:7,他引:12
Marusch F Koch A Schmidt U Geibetaler S Dralle H Saeger HD Wolff S Nestler G Pross M Gastinger I Lippert H 《Diseases of the colon and rectum》2002,45(9):1164-1171
INTRODUCTION: Anastomotic leakage is a major problem in colorectal surgery and in particular in operations for low rectal cancer. The present study investigates the question whether a protective stoma can reduce the (clinical and radiologic) anastomotic leakage rate and/or the rate of leakage requiring surgery. METHODS: The investigation took the form of a prospective multicenter study involving 75 German hospitals and was performed between January 1, 1999, and December 31, 1999. A comparison was made of the postoperative results of procedures performed with and those performed without a protective stoma in patients undergoing low anterior rectal resection. In addition, logistic regression using the target criteria, overall anastomotic leakage and anastomotic leakage requiring surgery, was applied. RESULTS: Among the 3,695 operations performed for carcinoma of the rectum or colon, 482 were low anterior resections. In 334 patients (69.3 percent) no protective stoma was constructed, whereas 148 (30.7 percent) received such protection. Age, American Society of Anesthesiologists physical status, and body mass index were identical in both groups. In the group receiving a protective stoma, however, neoadjuvant radiochemotherapy was more common, the tumors were lower-and thus the total mesorectal excision rate higher, the intraoperative complication rate was higher, and the duration of the operation was longer. The differences were all significant. The major criterion (overall anastomotic leakage rate) was identical in the two groups, but the rate of leakage requiring surgery was significantly lower in patients receiving a protective stoma (p = 0.028). The logistic regression revealed that use of a protective stoma is a predictor of protection against anastomotic leakage requiring surgery. The distance of the tumor from the anal verge and the duration of the operation are further predictors. CONCLUSION: The particular benefit of a covering stoma is reduction in the rate of leaks requiring surgery and thus in the severe consequences of an anastomotic leakage. 相似文献
8.
A. Karliczek N. J. Harlaar C. J. Zeebregts T. Wiggers P. C. Baas G. M. van Dam 《International journal of colorectal disease》2009,24(5):569-576
Background The dramatic clinical consequences of anastomotic leakage in gastrointestinal surgery can be reduced by a diverting stoma
or drainage of the peri-anastomotic area. Currently, the surgeons’ clinical judgement is of major importance in decision making,
but reliable data of the diagnostic accuracy are lacking. In this prospective clinical study, the surgeons’ predictive accuracy
for anastomotic leakage was evaluated.
Materials and methods In 191 patients undergoing colorectal resection with anastomosis, the risk for anastomotic leakage was determined by the surgeon
on the basis of a visual analogue scale (VAS). This risk assessment was compared to the actual occurrence of anastomotic leakage
post-operatively.
Results A total of 26 (13.6%) patients showed anastomotic leakage. The surgeons’ median predicted leakage rate was 7.1% in anastomoses
>15 cm from the anal verge and 9.5% ≤15 cm (sensitivity 38/62%, specificity 46/52%). Diagnostic accuracy was not influenced
by the surgeons’ training level (VAS score, surgeons 7.8% vs assistant surgeons 8.5%, p = 0.96, sensitivity 41% vs 44%, specificity 59% vs 48%, p = 0.20).
Conclusion The surgeons’ clinical risk assessment appeared to have a low predictive value for anastomotic leakage in gastrointestinal
surgery. The low a priori risk of anastomotic leakage of 14% resulted in a low post-test odds (11%) of correct prediction
of anastomotic leakage. This warrants the ongoing search for a better diagnostic test of anastomotic leakage to prevent morbidity
and mortality. 相似文献
9.
Mechanical bowel preparation for colorectal surgery: a meta-analysis on abdominal and systemic complications on almost 5,000 patients 总被引:1,自引:0,他引:1
Gravante G Caruso R Andreani SM Giordano P 《International journal of colorectal disease》2008,23(12):1145-1150
BACKGROUND: Several studies concluded that mechanical bowel preparation (MBP) does not confer any advantage on reducing the anastomotic leak rate or wound infections. The aim of this meta-analysis was to review all prospective randomised controlled trials on the use of MBP before colorectal surgery in order to find differences in the rates of abdominal and systemic complications in view of recent published articles. METHODS: Review of all randomised prospective trials compare MBP vs. non-MBP. Primary outcome measures were anastomotic leakages, abdomino-pelvic abscesses and postoperative ileus. Secondary outcomes were wound infections, extra-abdominal complications (urinary infections, pulmonary infections, deep venous thrombosis or pulmonary embolism, cardiac events), sepsis and mortality. RESULTS: Twelve articles met the inclusion criteria with 4,919 patients. The non-MBP group showed no significant increase of the anastomotic leakages (3.4% vs. 4.1%; p = NS) and wound infections (8.7% vs. 9.6%; p = NS) but had a lower rate of postoperative cardiac events (2.5% vs. 4.0%; p = 0.04). CONCLUSION: The evidence from recent studies, combined with previous ones, further suggests that the dogma of the necessity of mechanical bowel preparation before elective colorectal surgery should be reconsidered. 相似文献
10.
Dr. Hong Jo Choi M.D. Hyung Ho Kim M.D. Ghap Joong Jung M.D. Sang Soon Kim M.D. 《Diseases of the colon and rectum》1998,41(10):1281-1286
PURPOSE: Although sutureless anastomosis by use of the biofragmentable anastomotic ring is now accepted as an alternative to conventional manual sutured or stapled methods in elective enterocolic surgery, its applicability to emergency enterocolic surgery has not yet been established. The aim of this prospective study was to determine whether the biofragmentable anastomotic ring anastomosis in emergency enterocolic surgery could be performed as safely as in elective surgery or as emergency handsewn anastomosis. METHODS: To evaluate the safety and efficacy of sutureless bowel anastomosis by use of the biofragmentable anastomotic ring in emergency enterocolic surgery, a prospective, randomized study was undertaken to compare the biofragmentable anastomotic ring with conventional handsewn anastomotic technique. One hundred nineteen patients who required emergency laparotomy were randomly assigned to two groups: 56 patients (47 percent) underwent 58 biofragmentable anastomotic ring anastomoses, and 63 patients (53 percent) underwent 65 sutured anastomoses. In addition, the safety and efficacy of the biofragmentable anastomotic ring in emergency surgery were compared with those of the biofragmentable anastomotic ring in 86 elective biofragmentable anastomotic ring anastomoses performed in 84 patients during the same period of time. RESULTS: Specific intraoperative complications related to use of biofragmentable anastomotic rings occurred in six patients (10.7 percent), and another new biofragmentable anastomotic ring anastomosis was constructed in one patient. These reflected learning-curve errors, but they did not adversely affect the outcome. No statistical differences were observed among the groups with respect to wound complications, postoperative bleeding, intra-abdominal abscess, intestinal obstruction, or postoperative death. As for anastomotic leakage, six patients, two in each group, had complications of anastomotic failure, wherein four colonic fistulas required a diversion and two enteric fistulas closed spontaneously. Although there were no statistically significant differences in incidence of leaks among groups (P=0.4522), two fistulas in colocolic anastomoses, one in the suture group and the other in the biofragmentable anastomotic ring group, manifested the risk of primary anastomosis in emergency colon resection. Seven patients, three in the elective biofragmentable anastomotic ring group and two each in the emergency suture and biofragmentable anastomotic ring groups, died after the operation, but no deaths were directly attributed to the anastomotic technique used. CONCLUSION: The data suggest that the biofragmentable anastomotic ring is a safe and reliable alternative to conventional handsewn anastomosis in emergency enterocolic surgery, where the rapidity and security of anastomosis may be critical. Consideration, however, should be given to emergency primary colocolic or colorectal anastomosis, because of a high risk of anastomotic failure, although there are too few cases for a definite conclusion.Read at the 15th World Congress of Collegium Internationale Chirurgiae Digestivae, Seoul, South Korea, September 11 to 14, 1996. 相似文献
11.
Purpose
The aim of this study was to explore the choice of modality for diagnosis, treatments, and consequences of anastomotic leakage.Methods
This is a retrospective study of consecutive patients who underwent surgery that included a colorectal anastomosis due to colorectal cancer, diverticulitis, inflammatory bowel disease (IBD), or benign polyps.Results
A total of 600 patients were included during 2010–2012, and 60 (10%) had an anastomotic leakage. It took in mean 8.8 days (range 2–42) until the anastomotic leakage was diagnosed. A total of 44/60 of the patients with a leakage had a CT scan of the abdomen; 11 (25%) were initially negative for anastomotic leakage. Among all leakages, the anastomosis was taken down in 45 patients (76.3%). All patients with a grade B leakage (n = 6) were treated with antibiotics, and two also received transanal drainage. The overall complication rate was also significantly higher in those with leakage (93.3 vs. 28.5%, p < 0.001), and it was more common with more than three complications (70 vs. 1.5%, p < 0.001). There was a higher mortality in the leakage group.Conclusion
This study demonstrated that one fourth of the CT scans that were executed were initially negative for leakage. Most patients with a grade C leakage will not have an intact anastomosis. An anastomotic leakage leads to significantly more severe postoperative complications, higher rate of reoperations, and higher mortality. An earlier relaparotomy instead of a CT scan and improved postoperative surveillance could possibly reduce the consequences of the anastomotic leakage.12.
结直肠癌是消化道常见的恶性肿瘤,其发病率及死亡率逐年升高,手术治疗是目前治疗结直肠癌最有效的方法,但术后吻合口瘘依然是结直肠癌患者最常见、最严重的并发症之一。笔者对国内外关于结直肠癌术后吻合口瘘的研究做相关综述,以期能降低吻合口瘘的发生率。 相似文献
13.
Early removing gastrointestinal decompression and early oral feeding improve patients' rehabilitation after colorectostomy 总被引:14,自引:0,他引:14
Zhou T Wu XT Zhou YJ Huang X Fan W Li YC 《World journal of gastroenterology : WJG》2006,12(15):2459-2463
AIM: To evaluate the feasibility, safety, and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma. METHODS: Three hundred and sixteen patients submitted to operations associated with colorectostomy from January 2004 to September 2005 were randomized to two groups: In experimental group (n=161), the nasogastric tube was removed after the operation from 12 to 24 hours and was promised immediately oral feeding; In control group (n=155), the nasogastric tube was maintained until the passage of flatus per rectum. Variables assessed included the time to first passage of flatus, the time to first passage of stool, the time elapsed postoperative stay, and postoperative complications such as anastomotic leakage, acute dilation of stomach, wound infection and dehiscense, fever, pulmonary infection and pharyngolaryngitis. RESULTS: The median and average days to the first passage of flatus (3.0±0.9 vs 3.6±1.2, P<0.001), the first passage of stool (4.1±1.1 vs 4.8±1.4 P<0.001) and the length of postoperative stay (8.4±3.4 vs 9.6±5.0, P<0.05) were shorter in the experimental group than in the control group. The postoperative complications such as anastomotic leakage (1.24% vs 2.58%), acute dilation of stomach (1.86% vs 0.06%) and wound complications (2.48% vs 1.94%) were similar in the groups, but fever (3.73% vs 9.68%, P<0.05), pulmonary infection (0.62% vs 4.52%, P<0.05) and pharyngolaryngitis (3.11% vs 23.23%, P<0.001) were much more in the control group than in the experimental group. CONCLUSION: The present study shows that application of gastrointestinal decompression after colorectostomy can not effectively reduce postoperative complications. On the contrary, it may increase the incidence rate of fever, pharyngolaryngitis and pulmonary infection. These strategies of early removing gastrointestinal decompression and early oral feeding in the patients undergoing colorectostomy are feasible and safe and associated with reduced postoperative discomfort and can accelerate the return of bowel function and improve rehabilitation. 相似文献
14.
Factors determining delay in relaparotomy for anastomotic leakage after colorectal resection 总被引:4,自引:1,他引:3
Doeksen A Tanis PJ Vrouenraets BC Lanschot van JJ Tets van WF 《World journal of gastroenterology : WJG》2007,13(27):3721-3725
AIM: To analyze the time interval (‘delay') between the first occurrence of clinical parameters associated with anastomotic leakage alter colorectal resection and subsequent relaparotomy. METHODS: In 36 out of 289 consecutive patients with colorectal anastomosis, leakage was confirmed at relaparotomy. The medical records of these patients were retrospectively analysed and type and time of appearance of clinical parameters suggestive of anastomotic leakage were recorded. These parameters included heart rate, body temperature, local or generalized peritoneal reaction, leucocytosis, ileus and delayed gastric emptying. Factors influencing delay of relaparotomy and consequences of delayed recognition and treatment were determined.
RESULTS: First documentation of at least one of the predefined parameters for anastomotic leakage was alter a median interval of 4 ± 1.7 d alter the operation. The median number of days between first parameter(s) associated with leakage and relaparotomy was 3.5 ± 5.7 d. The time interval between the first signs of leakage and relaparotomy was significantly longer when a weekend was included (4.2 d vs 2.4 d, P = 0.021) or radiological evaluation proved to be false-negative (8.1 d vs 3.5 d, P = 0.007). No significant association between delay and number of additional relaparotomies, hospital stay or mortality could be demonstrated.
CONCLUSION: An intervening weekend and negative diagnostic imaging reports may contribute to a delay in diagnosis and relaparotomy for anastomotic leakage. That delay was more than two days in two-thirds of the patients. 相似文献
RESULTS: First documentation of at least one of the predefined parameters for anastomotic leakage was alter a median interval of 4 ± 1.7 d alter the operation. The median number of days between first parameter(s) associated with leakage and relaparotomy was 3.5 ± 5.7 d. The time interval between the first signs of leakage and relaparotomy was significantly longer when a weekend was included (4.2 d vs 2.4 d, P = 0.021) or radiological evaluation proved to be false-negative (8.1 d vs 3.5 d, P = 0.007). No significant association between delay and number of additional relaparotomies, hospital stay or mortality could be demonstrated.
CONCLUSION: An intervening weekend and negative diagnostic imaging reports may contribute to a delay in diagnosis and relaparotomy for anastomotic leakage. That delay was more than two days in two-thirds of the patients. 相似文献
15.
Ohtani H Ohta K Arimoto Y Kim EC Oba H Adachi K Terakawa S Tsubakimoto M 《World journal of gastroenterology : WJG》2005,11(44):6932-6935
AIM: To evaluate the usefulness of three-dimensional computed tomography (3DCT) in laparoscopic surgery for colorectal carcinoma. METHODS: Seventy-two patients with colorectal cancer who underwent curative operation at our hospital were enrolled in this study. They were classified into two groups by operative procedures. Sixteen patients underwent laparoscopic surgery, laparoscopic group (LG), while 56 patients underwent conventional open surgery, open group (OG). At our institution, contrast-enhanced CT is routinely performed as part of intra-abdominal screening and the 3D images of the major regional vessels are described. We have previously described about the preoperative visualization of the inferior mesenteric artery (IMA) by 3DCT. This time we newly acquired 3D images of the superior mesenteric artery (SMA)/superior mesenteric vein (SMV), ileocecal artery (ICA), middle colic artery (MCA), and inferior mesenteric vein (IMV). We have compared our two study groups with regard to five items, including clinical anastomotic leakage. We have discussed here the role of 3DCT in laparoscopic surgery for colorectal carcinoma. RESULTS: The mean length of the incision in LG was 4.625+/-0.89 cm, which was significantly shorter than that in OG (P<0.001). The association between ICA and SMV and SMA was described in the right-sided colectomy. The preoperative imaging of IMA and IMV was created in the rectosigmoidectomy. There was no significant difference in anastomotic leakage between the two groups, but no patients in LG experienced anastomotic leakage. CONCLUSION: Most of the patients are satisfied with the shorter incisional length following laparoscopic surgery. Preoperative visualization of the major regional vessels may be helpful for the secure treatment of the anastomosis in laparoscopic surgery for colorectal carcinoma. 相似文献
16.
Purpose
Damage control strategy (DCS) is a two-staged procedure for the treatment of perforated diverticular disease complicated by generalized peritonitis. The aim of this retrospective multicenter cohort study was to evaluate the prognostic impact of an ongoing peritonitis at the time of second surgery.Methods
Consecutive patients who underwent DCS for perforated diverticular disease of the sigmoid colon with generalized peritonitis at four surgical centers were included. Damage control strategy is a two-stage emergency procedure: limited resection of the diseased colonic segment, closure of oral and aboral colon, and application of a negative pressure assisted abdominal closure system at the initial surgery followed by second laparotomy 48 h later. Therein, decision for definite reconstruction (anastomosis or Hartmann’s procedure (HP)) is made. An ongoing peritonitis at second surgery was defined as presence of visible fibrinous, purulent, or fecal peritoneal fluid. Microbiologic findings from peritoneal smear at first surgery were collected and analyzed.Results
Between 5/2011 and 7/2017, 74 patients underwent a DCS for perforated diverticular disease complicated by generalized peritonitis (female: 40, male: 34). At second surgery, 55% presented with ongoing peritonitis (OP). Patients with OP had higher rate of organ failure (32 vs. 9%, p =?0.024), higher Mannheim Peritonitis Index (25.2 vs. 18.9; p =?0.001), and increased operation time (105 vs. 84 min., p =?0.008) at first surgery. An anastomosis was constructed in all patients with no OP (nOP) at second surgery as opposed to 71% in the OP group (p <?0.001). Complication rate (44 vs. 24%, p =?0.092), mortality (12 vs. 0%, p =?0.061), overall number of surgeries (3.4 vs. 2.4, p =?0.017), enterostomy rate (76 vs. 36%, p =?0.001), and length of hospital stay (25 vs. 18.8 days, p =?0.03) were all increased in OP group. OP at second surgery occurred significantly more often in patients with Enterococcus infection (81 vs. 44%, p =?0.005) and with fungal infection (100 vs. 49%, p =?0.007). In a multivariate analysis, Enterococcus infection was associated with increased morbidity (67 vs. 21%, p <?0.001), enterostomy rate (81 vs. 48%, p =?0.017), and anastomotic leakage (29 vs. 6%, p =?0.042), whereas fungal peritonitis was associated with an increased mortality (43 vs. 4%, p =?0.014).Conclusion
Ongoing peritonitis after DCS is a predictor of a worse outcome in patients with perforated diverticulitis. Enterococcal and fungal infections have a negative impact on occurrence of OP and overall outcome.17.
Intraoperative blood pressure changes as a risk factor for anastomotic leakage in colorectal surgery
Post IL Verheijen PM Pronk A Siccama I Houweling PL 《International journal of colorectal disease》2012,27(6):765-772
Purpose
Anastomotic leakage is a serious complication after colorectal surgery. Pre- and intraoperative factors may contribute to failure of colorectal anastomosis. In this study we have tried to determine risk factors for anastomotic leakage, with special emphasis on intraoperative blood pressure changes.Methods
During a 24-month period, patients receiving a colorectal anastomosis were prospectively evaluated. For each patient preoperative characteristics, intraoperative adverse events and surgical outcome data were collected. Blood pressure changes were calculated as a relative decrease (>25% and >40%) from preoperative baseline values.Results
During the study period, 285 patients underwent colorectal surgery with an anastomosis. Fifteen patients developed an anastomotic leakage (5.3%). All patients who developed a leakage had a left-sided procedure (P?0.001). When blood loss was more than 250?mL (P?=?0.003) or an intraoperative adverse event occurred (P?=?0.050), the risk for developing an anastomotic leakage was significantly increased. A preoperative high diastolic blood pressure of ≥90?mmHg (P?=?0.008) and severe intraoperative hypotension [>40% decrease in diastolic blood pressure (P?=?0.049)] were identified as univariate risk factors for anastomotic leakage.Conclusions
The development of an anastomotic leakage after colorectal surgery is related to surgical, patient and anaesthetic risk factors. A high preoperative diastolic blood pressure and profound intraoperative hypotension combined with complex surgery, marked by a blood loss of ≥250?mL and the occurrence of intraoperative adverse events, is associated with an increased risk of developing anastomotic leakage. 相似文献18.
Doeksen A Tanis PJ Wüst AF Vrouenraets BC van Lanschot JJ van Tets WF 《International journal of colorectal disease》2008,23(9):863-868
BACKGROUND AND AIMS: The purpose of this study was to determine the accuracy, interobserver variability, timing and discordance with relaparotomy of postoperative radiological examination of colorectal anastomoses. PATIENT/METHODS: From 2000 to 2005, 429 patients underwent an ileocolonic, colo-colonic, or colorectal anastomosis. Radiological examination of the anastomosis was not performed routinely, but only when there were clinically signs of leakage. Radiological imaging was reviewed by an independent radiologist and medical records were retrospectively analyzed. Clinical anastomotic leakage was the standard of reference and defined as leakage confirmed during relaparotomy, drainage of pus per anum or as an anastomotic defect identified at digital examination. RESULTS: Radiological evaluation of the anastomosis was performed in 91 patients (21%): CT in 27 patients, contrast radiography in 40, and both imaging modalities in 24 patients. The interobserver variability of CT and contrast radiography was 10% and 14%, respectively. The sensitivity and negative predictive value of imaging of the anastomosis was 65% and 73%, respectively. Anastomotic leakage was found in 11 of 21 patients (52%) who underwent relaparotomy despite negative imaging. Three of 36 patients (8%) with a diagnosis of anastomotic leakage based on radiological examination had an intact anastomosis at relaparotomy. CONCLUSION: Radiological imaging of the anastomosis after colorectal surgery should be restrictively applied and interpreted with caution because of the high false-negative rate and the substantial interobserver variability. 相似文献
19.
Krysa J Patel V Taylor J Williams AB Carapeti E George ML 《Diseases of the colon and rectum》2008,51(6):961-965
Purpose Patients on renal replacement therapy are reported to have a high complication rate after abdominal surgery, the result of
uremia and immunosuppression. A review of this group of patients undergoing colorectal surgery was undertaken.
Methods Seventy-three separate colorectal operations were performed for 44 patients. Thirty-eight patients were on dialysis and 35
had a renal transplant. Data (coexisting disease, preoperative blood results, operative details, complications, and colorectal
POSSUM score) were completed for each surgical event.
Results Forty-two elective and 31 emergency procedures were performed. Infective complications were common (overall 60 percent). There
were two anastomotic leaks in the elective group, but five leaks from seven emergency anastomoses. Stomas were frequently
raised. Ninety percent of patients who survived and had a defunctioning stoma underwent a successful reversal. The overall
major complication rate after elective and emergency surgery was 19 and 81 percent, respectively, and mortality was 5 and
26 percent, respectively.
Conclusions Renal patients have a high rate of complications after colorectal surgery, and emergency surgery has a significant risk of
anastomotic leak. Primary anastomosis should be avoided in all patients undergoing emergency intestinal resections. Subsequent
surgery to restore intestinal continuity is possible in 90 percent of patients with far fewer complications.
Presented at the meeting of the Royal Society of Medicine, Paris, France, May 31 to June 3, 2007, and the meeting of the Association
of Surgeons of Great Britain and Ireland, Manchester, England, April 18 to 20, 2007.
Reprints are not available. 相似文献
20.
Feng B Zheng MH Mao ZH Li JW Lu AG Wang ML Hu WG Dong F Hu YY Zang L Li HW 《Aging clinical and experimental research》2006,18(3):191-195
BACKGROUND AND AIMS: Elderly patients have a high incidence of colorectal cancer, which may be associated with increased morbidity and mortality due to complex comorbidity and diminished cardiopulmonary reserves. The aims of this study were to compare the outcomes of laparoscopic colorectal cancer surgery with those observed in traditional open surgery in patients aged over 70 years. METHODS: Between January 2003 and October 2004, 51 patients aged over 70 years with colorectal cancer, who underwent laparoscopic surgery (LAP group), were evaluated and compared with 102 controls (also over 70 years old) treated by traditional open surgery (OPEN group) in the same period. All patients were evaluated with respect to the American Society of Anesthesiologists (ASA) classification, surgery-related complications, and postoperative recovery. RESULTS: No surgery-related death was observed in the LAP group, whereas two deaths occurred in the OPEN group for severe post-operative pulmonary infection and anastomotic leak, respectively. No pneumoperitoneum-related complications were observed in the LAP group; 2 (3.9%) patients required conversion to open surgery, because of the unexpectedly bulky tumor and severe adhesions in the abdominal cavity. With the increase in patients' age, increased ASA classification was observed. No significant differences were observed in gender, Dukes' staging or types of procedures between LAP and OPEN groups. The overall morbidity in the LAP group was significantly less than that of the OPEN group [17.6% (9/51) vs 37.3% (38/102), p=0.013]. Mean blood loss, time to flatus passage, and time to semi-liquid diet in the LAP group were significantly shorter than those of the OPEN group (90.7+/-49.9 vs 150.3+/-108.7 ml, 2.4+/-1.2 vs 3.5+/-2.9 d, 5.0+/-1.8 vs 5.9+/-1.2 d, respectively, p<0.05). No significant differences were observed in terms of mean operation time or hospital stay between LAP and OPEN groups. CONCLUSION: Laparoscopic colorectal cancer surgery in elderly patients with colon cancer has clinically significant advantages over traditional open surgery, and appears to be the ideal surgical choice for the elderly. 相似文献