支撑捆扎法在超低位直肠癌保留肛门括约肌手术中的应用

Application of "Supporting Bundle-up Technique" on Sphincter Preserved Procedure for Ultralow Rectal Cancer

目的探讨支撑捆扎法在超低位直肠癌保留肛门括约肌手术中的应用。方法对117例直肠癌患者采用支撑捆扎法完成超低位结肠-直肠(肛管)吻合术。患者均在术前行纤维结肠镜检查和活组织检查,确诊为直肠腺癌,且经直肠腔内B超、盆腔CT及MR I排除肿瘤侵犯肛提肌和盆腔淋巴结广泛转移。结果117例超低位直肠癌保肛手术围手术期呼吸衰竭死亡1例,术后吻合口漏2例,1例局部引流治愈,1例直肠阴道瘘行横结肠造瘘转流手术。未发生吻合口狭窄,术后3月排便功能评价:优29例,良44例,一般31例,差13例,优良率为62.4%(73/117)。结论支撑捆扎法用于直肠癌保留肛门括约肌手术安全、可行,可以完成从肛提肌内口到括约肌间沟的结肠-直肠(肛管)吻合,效果良好。

Objective To introduce the application of supporting bundle-up technique on the anterior resection for the ultralow rectal cancer. Method 117 cases of ultralow rectal cancer underwent anterior resection with a supporting bundle-up technique. All cases were pathologically diagnosed by preoperative endoscopi biopsy. Cases with cancer infiltration of levator muscle and extensive pelvic lymph node metastasis indicated by intrarectal ultrasound, pelvis CT or MRI were excluded. Result There was 1 death of respiratory failure, 2 cases of anastomotic leakage. Curative regional drainage was given in 1 case and transverse colostomy was conducted for the rectovaginal fistula in 1 case. No occurrence of anastomotic stricture observed. The excellent rate was 62.4%. Conclusion The supporting bundle-up technique is safe and applicable for the ultralow anastomosis between the levator muscle and constrictor groove.