结直肠手术吻合口漏的预测模型及预防策略

Predictive models and prophylactic strategies for anastomotic leakage in colorectal surgery

吻合口漏始终是困扰结直肠外科医生的一个顽疾,技术和设备的进步并未降低其发生率。随着循证医学的发展,越来越多的吻合口漏高危因素被发现。如何高效而系统地组合利用这些孤立的风险因子并量化之,给临床提供科学的吻合口漏风险预警,从而帮助术者制定围手术期预防策略,对降低术后吻合口漏的发生率有重要意义。目前,结直肠吻合口漏的预测模型大体可以分为预后型模型(术前和术中用于预测吻合口漏发生的风险)和诊断型模型(早期预警,辅助提高吻合口漏早期诊断率)两类。针对结直肠吻合口漏的防治策略主要有控制基础疾病和纠正贫血及低蛋白血症、选择合适的手术时间窗、重视和改进吻合技术(包括选择合适的吻合器型号)等,但预防性肠造口仍然是目前最主要的防治措施。如何降低预防性造口的并发症率,如何降低预防性造口的永久化率都是当前临床需要探讨的重要问题。

Anastomotic leakage(AL)has always been a persistent issue for colorectal surgeons.It is still difficult to reduce the incidence of AL despite the advances in technology and equipment.With the development of evidence-based medicine,increasing high-risk factors for AL have been identified.How to efficiently and systematically combine and quantify these isolated risk factors to provide a scientific early warning of AL in clinical practices and help surgeons in choosing the optimal prophylactic strategies,is of great significance for reducing the incidence of AL.There are generally two types of AL prediction models in colorectal surgery,including prognostic models(for preoperative and intraoperative AL prediction)and diagnostic models(for early warning and improving the early diagnosis rate of AL).Prophylactic strategies for AL include stabilizing the underlying diseases,improving anemia and hypoalbuminemia,choosing an appropriate operative time window,and emphasizing and improving anastomotic techniques(including choosing an appropriate size of stapler).However,a prophylactic ostomy is still the most common method for surgeons.However,how to reduce the morbidity of complications following prophylactic ostomy and how to avoid the conversion of the prophylactic stoma to permanent stoma need further study.