支撑捆扎法在低位直肠癌超低位前切除术中的应用

The use of supporting-bundling up method for ultra-low anterior resection of low rectal cancer

目的介绍一种新的直肠癌保留肛门括约肌手术术式,即支撑捆扎法低位(超低位)结肠-直肠(肛管)吻合术。方法回顾性分析近12年来采用支撑捆扎法进行直肠癌保留肛门手术(保肛组)310例的临床资料。结果全组肿瘤距离肛缘的平均距离为(4.7±1.2)cm。TNM分期:Ⅰ期40例,Ⅱ期130例,Ⅲ期109例,Ⅳ期31例。吻合口距肛缘平均距离为2cm(1～4cm)。术后吻合口漏发生率2.3%,肛门括约肌控制力优良率为82.25%。中位随访时间为84个月(12～186个月),310例患者中5年内有18例局部复发,局部复发率为5.8%。全组中位生存时间(57.8±2.739)个月,平均生存时间(67.494±1.738)个月。结论支撑捆扎法是一种安全、可行的直肠癌保留肛门括约肌的手术技术,可以完成从肛提肌内口到括约肌间沟的结肠-直肠(肛管)吻合术,不影响肿瘤的根治原则、远期效果良好。

Objective To introduce a new anus preserving operation for low rectal cancer-ultralow anterior resection and colorectal/coloanal anastomosis by using supporting-bundling up method. Methods The clinical data of 310 patients who underwent anus preserving operation by supporting-bundling up method for low rectal cancer were retrospectively reviewed. Results The mean distance of tumor from the anal verge was 4.7 ± 1.2era; the TNM stage was stage Ⅰ in 40 cases, stage 11 30 cases, stage m 109 cases and stage Ⅳ 31 cases, the mean distance of the anastomosis from the anal verge was 2 cm （ 1 - 4 cm ）. the occurrence rate of postoperative anastomosis leak was 2.3 % , the rate of excellent anal sphincter control was 82.25 % . The 5-year local recureence rate was 5. 8%. Conclusions Ultralow anterior resection and colorectal/coloanal anastomosis by supporting-bundling up method may be one of the best anus preserving operations for low rectal cancer. It is a safe and feasible operation, and the long-term outcome is excellent.