经腹肛直肠拉出切除吻合术的应用(附70例报告)

CLINICAL APLICATION OF ABDOMINANUS REC-TUM PULLING OUT RESECTION AND ANASTOMOSIS

在70例中低位直肠癌行保留肛门的直肠癌根治术患者中,肿瘤下缘距肛缘5～8cm,术后吻合口距齿线0～3cm,认为癌肿距肛缘≥5cm,肿瘤分化程度较高、无远处转移及周围浸润,行保肛手术是可行的。术中应充分游离乙状结肠及降结肠中下段,注意保证血运,直肠分离至尽量低位,将直肠及乙状结肠拉出于肛门外边切边缘,或切断后拉出吻合,注意斜口吻合。强调术中病理检查及吻合口缝合技术的重要性,提出并发症的预防措施。

Radical resection of rectal cancer with preserving anus has been done in 70 casses of middle and lower part rectal cancer. The distance between the lower borderline of the tumor and the anus is 5 - 8cm. The postoperative anastomosis away from the dentale line is 0 -3cm. The authors consider that such preserving anus operation is feasible if the location of the tumor away from the anus is > 5cm, the differentiation degree of the tumor is comparative high, and there is no distal metastasis and peripheral invasion. The sigmoid and the middle and lower part of the descending colon must be dissociated sufficiently during the operation. At the same time, one must pay attention to the blood supply of the sigmoid. The dissociation of the rectum must be as low as possible. The sigmoid-anus anastomosis should take place outside the anus. The importance of pathological examination during the operation and the skill of anastomosis suture are emphasied. The measures for preventing complications are also put for-ward in the article.