全直肠系膜切除联合单吻合器行直肠癌保肛手术41例报道

Total mesorectal excision combined single stapler in rectal cancer with preservation of the anus:Report of 41 cases

目的:探讨全直肠系膜切除联合单吻合器在低位直肠癌中的应用效果。方法:在全直肠系膜切除(TME)基础上,对41例低位直肠癌应用单管状吻合器与荷包钳做保肛手术,随访5年,回顾性分析其根治性、术后排便功能、手术并发症、局部复发率。结果:全组无手术死亡,术后病理学检查无切端癌残留,无大便失禁,无吻合口漏发生,吻合狭窄2例,发生率4.88%(2/41),术后随访5年,局部复发3例,复发率为7.32%(3/41),患者术后肛门功能恢复较满意。结论:全直肠系膜切除应用单吻合器与荷包钳用于低位直肠癌切除术简便易行,吻和效果满意,较双吻合器行直肠癌保肛手术节省费用。

Objective：To investigate the effect of total mesorectal exci- sion combined single stapler in surgical treatment of low carcinoma. Methods： The total 41 cases with low carcinoma undergone total me,rectal excision by using single stapler and purse pliers with preser- vation of the anus were followed up for 5 years. Those data were retro- spectively reviewed in light of radical results, postoperative bowel movement, surgical cornplications and rate of local recurrence. Results： No single death occurred in the total 41 cases, and also postoperative patho- logic findings revealed no fraction of residue by the excised marginal site, occurrence of fecal incontinence, anastomotic leadage except 2 cases of stricture（4.88% ;2/41 ）. In five years of the follow-up after operation, local recurrence was found in 3 cases（ 7.32 % ）, and in general, rehabili- tation of the anal function achieved .satisfactorily. Conclusion： Total mesorectal excision with single stapler and purse pliers in management of low rectal cancer with preservation of the anus is much safer and more reliable in comparison with double stapling besides low costs.