Publikationsserver der Universitätsbibliothek Marburg
Titel:Wertigkeit der Luftprobe nach (Stapler-)Anastomosen bei kolorektalen Anastomosen
Autor:Bonney, Nora Anne
Weitere Beteiligte: Fendrich, Volker (Prof. Dr.)
Veröffentlicht:2017
URI:https://archiv.ub.uni-marburg.de/diss/z2018/0172
DOI: https://doi.org/10.17192/z2018.0172
URN: urn:nbn:de:hebis:04-z2018-01720
DDC: Medizin
Publikationsdatum:2018-10-15
Lizenz:https://rightsstatements.org/vocab/InC-NC/1.0/

Dokument

Schlagwörter:
Dickdarmkrebs, Anastomoseninsuffizienz Risikofaktoren Luftprobe, anastomotic leakage risk factors air leak test, Anastomose

Zusammenfassung:
Hintergrund Die Anastomoseninsuffizienz (AI) stellt immer noch eine der gefürchtetsten Komplikationen in der kolorektalen Chirurgie dar (Buchs et al. 2008). Die Luftprobe ist die am häufigsten intraoperativ durchgeführte Methode um die Dichtigkeit einer neu angelegten Anastomose zu testen und eine insuffiziente Naht zu detektieren (Nachiappan et al. 2014). Welche Aussagekraft das Ergebnis der Luftprobe im Hinblick auf das Anastomoseninsuffizienz-Risiko besitzt, wurde bisher selten beleuchtet. Daher entschieden wir uns dazu, in dieser Arbeit die Wertigkeit der Luftprobe und als Nebenaspekt mögliche Risikofaktoren für eine Anastomoseninsuffizienz zu überprüfen. Methoden Im Rahmen einer retrospektiven Studie wurden die Daten von allen Patienten mit kolorektalem Karzinom untersucht, die zwischen 2009-2014 in der Viszeralchirurgie der Uniklinik Marburg behandelt wurden. Von 588 untersuchten Datensätzen erfüllten 237 Patienten die Einschlusskriterien. Die Parameter Alter, Geschlecht, Entität des kolorektalen Karzinoms, Art des chirurgischen Eingriffs, laparoskopisch assistierte versus offene Vorgehensweise, Einsatz eines Staplers versus Handnaht, Ergebnis der Luftprobe, Vorgehensweise bei undichter Luftprobe (Übernähen), postoperative Anastomoseninsuffizienz, Grad der Anastomosenin-suffizienz, Dauer der Operation, Notfall- versus elektive Operation, anästhesiologische Para-meter wie intraoperatives Flüssigkeitsmanagement, intraoperative Blutprodukttransfusion und intraoperative Katecholamingabe und präoperative Risikofaktoren wie Alkohol- und Nikotinabusus, Diabetes mellitus, Body- Mass- Index, ASA- Score und Vorbehandlung im Sinne einer neoadjuvanten Radiochemotherapie wurden erhoben. 83 Ergebnisse Bei allen der 237 Patienten des Gesamtkollektivs wurde eine Luftprobe durchgeführt, wobei insgesamt 42 (17,7%) der Patienten eine postoperative Insuffizienz entwickelten. Die Luftprobe hatte sich bei 224 (94,5%) Patienten der 237 Patienten des Gesamtkollektivs intraoperativ als dicht erwiesen. Primär undichte Luftproben zeigten sich bei 13 (5,5%) aller Patienten. Von den 224 Patienten mit dichter Luftprobe entwickelten 39 Patienten eine AI (17,42%). Von den 13 Patienten mit primär undichter Luftprobe wurde bei 3 Patienten (23,1%) eine AI beobachtet. Der p-Wert der Korrelation zwischen Ergebnis der Luftprobe und dem Auftreten einer postoperativen Nahtinsuffizienz lag bei 0,7065; somit war der Unterschied der AI-Raten zwischen den Patienten nach primär dichter bzw. nach undichter Luftprobe statistisch nicht signifikant. Bei der univariaten Analyse der Risikofaktoren ergaben sich keine Signifikanzen. Schlussfolgerung Ist eine Luftprobe primär undicht, gleicht das Insuffizienzrisiko nach Übernähung der Anastomose dem Risiko eine Nahtinsuffizienz nach initial dichter Luftprobe zu entwickeln. Folglich lässt sich vermuten, dass nach undichter Luftprobe das Übernähen der Anastomose genügt und eine Neuanlegung derselben nicht notwendig ist. Da sich in der Analyse der einzelnen Risikofaktoren keine Signifikanzen zeigten, bleibt das Insuffizienzrisiko, das eventuell durch eine Kombination unterschiedlicher Einzelfaktoren beeinflusst wird, statistisch nicht abschätzbar. Den entscheidenden Einzelfaktor hingegen könnten das technisch korrekte Anlegen der Anastomose selbst und das damit assoziierte individuelle chirurgische Können darstellen. Um die technische Korrektheit der Anastomose zu überprüfen, erscheint die Luftprobe aussagefähig. Da das weitere Insuffizienzrisiko jedoch wahrscheinlich auch von anderen Umständen abhängig ist, ist die Luftproben nur begrenzt fähig das tatsächliche Anastomoseninsuffizienz-Risiko vorherzusagen. (Wu et al. 2016). Die Wertigkeit der Luftprobe scheint also eingeschränkt.

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