通过优先保留直肠上动脉以降低家族性腺瘤性息肉病患者在全结肠切除术和回盲肠直肠吻合术中的吻合口破裂率。
Superior rectal artery preservation to reduce anastomotic leak rates in familial adenomatous polyposis patients treated with total colectomy and ileorectal anastomosis.
发表日期：2023 Sep 09
作者：
E Rausa, G Colletti, C M Ciniselli, S Signoroni, V Duroni, F Cavalcoli, A Magarotto, M T Ricci, C Brignola, D Biasoni, P Verderio, M Vitellaro
来源：
Techniques in Coloproctology
摘要：
全结肠切除术联合远段回肠吻合术（TC / IRA）是家族性腺瘤性息肉病（FAP）患者中的一种预防性手术选择之一。本研究调查了在TC / IRA中保护腹股沟上动脉（SRA）对降低吻合口漏的有效性。该回顾性研究基于在意大利米兰国家癌症研究所（01/2000 - 12/2022）收集的前瞻性数据。参与TC / IRA的FAP患者被纳入研究。进行了1：1的倾向评分匹配（PSM）。使用单变量和多变量分析研究SRA保护与并发症之间的关联。研究人群包括211例接受TC / IRA的患者（性别：106男，105女；年龄：中位数30岁，IQR：20-48岁）中，82例保护了SRA（SRA组），129例未保护了SRA（对照组）。经过PSM，每组考虑了75例患者。单变量逻辑回归分析显示，SRA保护与较少的并发症相关（OR 0.331，95% CI 0.116; 0.942）。SRA组中的AL事件比对照组中的事件明显较少（0 vs 12，p=0.028）。SRA组的总体手术并发症和盆腔感染率较低（p=0.020和p=0.028）。SRA组的中位手术时间显著较长（340分钟vs240分钟，p<0.001），而住院时间则明显较短（6天vs7天，p=0.017）。SRA组中有27例患者出现术中吻合口出血，通过内镜进行了控制。分析整个患者队列得出了相似的结果。尽管手术过程中需要额外的技术步骤并因此延长手术时间，但在这类患者群体中，可以考虑保留SRA的优势。建议术中进行内镜检查可能发生吻合口出血的部位。© 2023.Springer Nature Switzerland AG.
Total colectomy with ileorectal anastomosis (TC/IRA) is one of the prophylactic surgical options in patients with familial adenomatous polyposis (FAP). This study investigated the effectiveness of superior rectal artery (SRA) preservation during TC/IRA in reducing anastomotic leakage (AL).This retrospective study was based on prospectively collected data (01/2000 - 12/2022) at the National Cancer Institute, Milan, Italy. FAP patients undergoing TC/IRA were enrolled. A 1:1 propensity score matching (PSM) was performed. Associations between SRA preservation and complications were investigated using univariate and multivariate analysis.The study population included 211 patients undergoing TC/IRA (Sex: 106 Male, 105 Female; Age: median 30 yrs, IQR: 20-48 yrs), 82 with SRA preservation (SRA group) and 129 without SRA preservation (controls). After PSM, 75 patients were considered for each group. SRA preservation was associated with fewer complications (OR 0.331, 95% CI 0.116; 0.942) in univariate logistic regression analysis. AL events were significantly fewer in the SRA group than in the control group (0 vs 12, p = 0.028). The SRA group had fewer overall surgical complication and pelvic sepsis rates (p = 0.020 and p = 0.028, respectively). Median operative time was significantly longer in the SRA group (340 min vs 240 min, p<0.001), and median hospital stay was significantly shorter (6 vs 7 days, p=0.017). Twenty-seven patients in the SRA group experienced intraoperative anastomotic bleeding, which was controlled endoscopically. Superimposable results were obtained analyzing the whole patient cohort.SRA preservation can be considered an advantage in this patient population, despite adding a further technical step during surgery and thereby prolonging the operative time. Intraoperative endoscopic checking of possible anastomotic bleeding sites is recommended.© 2023. Springer Nature Switzerland AG.