직장암 절제술 후 문합부 누출에 대한 복강경 수술과 개복술의 비교연구
Anastomotic Leakage after Laparoscopic versus Open Resection for Rectal Cancer: - A Retrospective Study -
이두석, 육의곤, 최성일, 이두한, 김도선, 문홍영,
소속 상세정보
이두석 ( Lee Doo-Seok )
대항병원 외과
육의곤 ( Youk Eui-Gon )
대항병원 외과
최성일 ( Choi Sung-Il )
대항병원 외과
이두한 ( Lee Doo-Han )
대항병원 외과
김도선 ( Kim Do-Sun )
대항병원 외과
문홍영 ( Moon Hong-Young )
고려대학교 의과대학 외과학교실
KMID : 0356720070230050350
Abstract
Purpose: This study is to compare the rate and pattern of anastomotic leakage (AL) for rectal cancer after laparoscopic vs. conventional open surgery at high and low rectal anastomosis and to evaluate whether the number of linear staples used for distal rectal resection is related to AL in laparoscopic group.
Methods: One hundred ninety-seven patients who underwent a curative resection for rectal cancer between March 2002 and February 2006 were studied retrospectively (107 laparoscopic, 90 open). The proportions of patients with anastomosis above vs. below 5 cm from AV were not different between the laparoscopic and the open groups; (above/below: 54/53 and 41/49, respectively, P=0.57). The protective stoma rate, the overall rate of AL, the rate of AL according to the height of the anastomosis, and the number of distal linear staples were evaluated for both groups.
Results: Clinical AL occurred in 11 of 107 patients (10.3%) for the laparoscopic group and in 5 of 90 patients (5.6%) for the open group. The rates of AL in patients without protective stoma were not significantly different for high rectal anastomosis (6.0% for laparoscopic vs. 2.6% for open, P= 0.63) and for low rectal anastomosis (25.8% for laparoscopic vs. 12.1% for open, P=0.21). The risk of AL was 4.9 times higher when 3 linear staples were used than when 2 linear staples were used in the laparoscopic group.
Conclusions: There was no statistical difference in AL between the laparoscopic group and the open group. The rate of AL could be reduced by using fewer linear staples for distal rectal resection in the laparoscopic group
키워드
문합부 누출;복강경 절제술;직장암;선형봉합기
Anastomotic leakage;Laparoscopic resection;Rectal cancer;Linear staple
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