Anastomotic leakage(AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low an...Anastomotic leakage(AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection(LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR.展开更多
Every colorectal surgeon during his or her career is faced with anastomotic leakage(AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mor...Every colorectal surgeon during his or her career is faced with anastomotic leakage(AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional and oncologic outcome and drainage on hospital resources. In order to understand and give an overview of the AL risk factors in laparoscopic colorectal surgery, we carried out a careful review of the existing literature on this topic and found several different definitions of AL which leads us to believe that the lack of a consensual, standard definition can partly explain the considerable variations in reported rates of AL in clinical studies. Colorectal leak rates have been found to vary depending on the anatomic location of the anastomosis with reported incidence rates ranging from 0 to 20%, while the laparoscopic approach to colorectal resections has not yet been associated with a significant reduction in AL incidence. As well, numerous risk factors, though identified, lack unanimous recognition amongst researchers. For example, the majority of papers describe the risk factors for left-sided anastomosis, the principal risk being male sex and lower anastomosis, while little data exists defining AL risk factors in a right colectomy. Also, gut microbioma is gaining an emerging role as potential risk factor for leakage.展开更多
The adjustment of the gas drainage rate has an immediate impact on air leakage in gob,thus resulting in the change of self-heating of coal.While regulating the gas drainage parameters,the risk of spontaneous combustio...The adjustment of the gas drainage rate has an immediate impact on air leakage in gob,thus resulting in the change of self-heating of coal.While regulating the gas drainage parameters,the risk of spontaneous combustion of coal should be considered.The risk assessment of gas control and spontaneous combustion of coal under gas drainage in a tunnel was investigated at different gas drainage rates.The distributions of the air volume along the working face,the gas management effects and the width of the oxidation zone were subjected to risk analysis.As the simulation results showed,with increasing gas drainage rate,although the safety of gas dilution by ventilation was assured,the intensifying air leakage caused the oxidation zone to move into the deeper gob and led to an increase in the width of the oxidation zone.A risk assessment method was proposed to determine a suitable gas drainage rate for the upper tunnel.The correctness of the risk assessment and the validity of the numerical modelling were confirmed by the field measurements.展开更多
文摘Anastomotic leakage(AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection(LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR.
文摘Every colorectal surgeon during his or her career is faced with anastomotic leakage(AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional and oncologic outcome and drainage on hospital resources. In order to understand and give an overview of the AL risk factors in laparoscopic colorectal surgery, we carried out a careful review of the existing literature on this topic and found several different definitions of AL which leads us to believe that the lack of a consensual, standard definition can partly explain the considerable variations in reported rates of AL in clinical studies. Colorectal leak rates have been found to vary depending on the anatomic location of the anastomosis with reported incidence rates ranging from 0 to 20%, while the laparoscopic approach to colorectal resections has not yet been associated with a significant reduction in AL incidence. As well, numerous risk factors, though identified, lack unanimous recognition amongst researchers. For example, the majority of papers describe the risk factors for left-sided anastomosis, the principal risk being male sex and lower anastomosis, while little data exists defining AL risk factors in a right colectomy. Also, gut microbioma is gaining an emerging role as potential risk factor for leakage.
基金financially sponsored by the National Natural Science Foundation of China (Nos. 51774114 and 51404090)
文摘The adjustment of the gas drainage rate has an immediate impact on air leakage in gob,thus resulting in the change of self-heating of coal.While regulating the gas drainage parameters,the risk of spontaneous combustion of coal should be considered.The risk assessment of gas control and spontaneous combustion of coal under gas drainage in a tunnel was investigated at different gas drainage rates.The distributions of the air volume along the working face,the gas management effects and the width of the oxidation zone were subjected to risk analysis.As the simulation results showed,with increasing gas drainage rate,although the safety of gas dilution by ventilation was assured,the intensifying air leakage caused the oxidation zone to move into the deeper gob and led to an increase in the width of the oxidation zone.A risk assessment method was proposed to determine a suitable gas drainage rate for the upper tunnel.The correctness of the risk assessment and the validity of the numerical modelling were confirmed by the field measurements.
