吻合方式对克罗恩病肠部分切除后吻合口瘘的影响

目的探讨克罗恩病(CD)患者肠切除+肠吻合术不同的吻合方式对CD术后吻合口瘘的影响。方法回顾性分析2000年12月至2013年12月在解放军第八五医院行肠切除肠吻合术的CD患者42例的临床资料,比较实施侧侧吻合(SSA组,22例)与端侧或端端吻合(非SSA组,20例)两组患者的术后吻合口瘘发生情况。结果两组患者的年龄、性别、吸烟史及术前存在脓肿或瘘管情况无统计学差异(P>0.05)。术后非SSA组有30.0%(6/20)发生了不同程度的吻合口瘘,而SSA组仅有4.5%(1/22)发生了吻合口瘘(P<0.05);吻合口瘘外手术相关并发症发生率在两组无明显差异,分别为13.6%(3/20)和15.0%(3/22)(P=0.15);术后平均住院时间在非SSA组和SSA组分别为12.3 d和9.7 d(P<0.05),SSA组明显缩短。结论相比较于端端吻合与端侧吻合,侧侧吻合方式吻合口瘘的发生率明显降低,优点明显,可考虑作为CD肠切除后首选的吻合方式。

Impact of anastomosis type on anastomotic leakage after bowel resection for Crohn disease

Objective To determine whether different anastomosis is associated with anastomotic leakage after bowel resection for Crohn disease （CD）. Methods A retrospective analysis was carried out of patients who underwent bowel resection for CD at The 85th Hospital of the PLA from 2000 to 2013. Anastomotic fistula in patients with SSA was compared with that in patients with non-SSA. Results The age, sex, smoking history and preoperative abscess or fistula had no significant difference between the SSA and non-SSA （P＆gt;0.05）. The postoperative anastomotic leakage rate was 30.0%（6/20） in the non-SSA group, and was only 4.5%（1/22） in the SSA group （P＆lt;0.05）. Significant difference was found between the two group of non-anastomotic fistula complication rate （P＆lt;0.05）. Mean postoperative hospital stay of the SSA group was significantly shorter. Conclusion SSA is associated with decreased anastomotic fistula as compared to non-SSA.