全球精选文摘 - 结直肠手术后包裹性吻合口瘘：我们的行动太慢了吗？

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结直肠手术后包裹性吻合口瘘：我们的行动太慢了吗？

Contained Anastomotic Leaks After Colorectal Surgery: Are We Too Slow to Act?

Damrauer SM, Bordeianou L, Berger D 2009/8/14 20:26:54

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Arch Surg, 2009,

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Hypothesis:
Contained and free anastomotic leaks, which occur in a small percentage of patients after colorectal surgery, are different clinical entities and consequently should be managed differently.

Design:
Retrospective medical record review.

Setting:
Academic medical center.

Patients:
Patients who underwent colectomy with primary anastomosis (N=4019) between January 1, 1992, and December 13, 2004, were eligible for participation in the study. Fifty-eight patients (1.5%) with an anastomotic leak demonstrated by communication between the collection and the gastrointestinal tract were identified. Twenty-eight of the patients had free leaks and 30 had contained leaks.

Main Outcome Measures:
Time to presentation, symptoms at presentation, rates of reexploration, and inhospital mortality.

Results:
Baseline characteristics, presenting symptoms, physical examination findings, and laboratory values were similar between patients with contained and free leaks. Almost all patients with free leaks were taken directly to the operating room, whereas those with contained leaks were initially more likely to be treated nonoperatively. However, 24 of the 28 patients with contained leaks (86%) ultimately required surgical intervention. Inhospital mortality was the same in both groups (18% in the contained leak group and 17% in the free leak group).

Conclusions:
In patients with contained leaks who have documented communication between the abscess cavity and the bowel, there is no difference in the rate of operative management or morbidity and mortality when compared with those with free leaks. This finding suggests that the categorization of leaks as free or contained may not be justified and argues for early operative intervention even in patients with contained leaks.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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