Anastomotic Strictures after Colorectal Surgery: A Single Center Experience

大腸直腸手術後吻合狹窄：單一醫學中心經驗

葉哲輝(Che-Hui Yeh) ； 林秉緯(Ping-Wei Lin) ； 許希賢(Hsi-Hsien Hsu) ； 劉建國(Chien-Kuo Liu) ； 梁偉雄(Wai-Hung Leung) ； 楊靖國(Ching-Kuo Yang) ； 蔡柏立(Po-Li Tsai) ； 陳建勳(Jian-Syun Chen)

《中華民國大腸直腸外科醫學會雜誌》 33卷3期 (2022/09) Pp. 109-116

https://doi.org/10.6312/SCRSTW.202209_33(3).11101

摘要

Purpose. Up to 30% of patients develop anastomotic strictures after colorectal surgery. Although many are asymptomatic, these strictures may influence the continuity of the gastrointestinal tract and stoma closure. Currently, the optimal management of strictures remains unclear. Repeat surgical resection and endoscopic intervention may help achieve patency. This study aimed to review cases in our hospital and discuss treatment strategies. Methods. Eleven patients diagnosed with anastomotic strictures between January 2015 and December 2019 were included in this study. The anastomotic stricture was defined as failure to pass an endoscope through the anastomotic ring during postoperative follow-up. Demographic characteristics, primary surgical outcomes, stricture characteristics, management, and long-term follow-up were analyzed. Results. The median body mass index of all patients was 23.67. Seven of them had a history of smoking. All patients were diagnosed as anastomotic stricture after operation of left colon cancer. Seven patients previously had a low anterior resection, and four had an anterior resection. Five patients had anastomotic leakage after the initial surgery. All the anastomotic strictures were benign. Four patients received only endoscopic balloon dilation. Three patients received redo surgery. Four patients received multiple modality treatment. The success rates for endoscopic balloon dilation and repeat surgery were 75% and 50%, respectively. Anastomotic stricture failed to be treated in two patients due to pelvic recurrence. Conclusions. Anastomotic strictures are late complications that are difficult to treat. Optimizing the risk factors and reducing leakage are important to prevent strictures. Endoscopic balloon dilation is an acceptable intervention for benign strictures in select patients.

關鍵字

Anastomotic stricture ； Management ； Endoscopic balloon dilation

並列摘要

高達30%病人在大腸直腸手術後發生吻合狹窄，儘管大部分無症狀，吻合狹窄可能影響消化道的連續性及後續造口關閉。最佳處理方式目前仍無定論，反覆的手術切除及內視鏡治療或許可以改善狹窄。我們蒐集2015年1月至2019年12月，一共11位吻合狹窄的病人，其中7位病人接受低前位切除，4位病人接受前位切除。5位病人在初次術後發生吻合滲漏。所有吻合狹窄皆為良性，有4位病人僅接受內視鏡治療，有3位病人僅接受手術切除，4位病人同時接受內視鏡治療及手術治療。使用內視鏡氣球擴張術及再次手術的治療成功率分別為75%及50%。2位病人因為骨盆腔腫瘤復發而無法進行吻合狹窄治療。

並列關鍵字

吻合狹窄 ； 治療 ； 內視鏡氣球擴張術