双吻合技术在中低位直肠癌保肛手术中的临床应用

Clinical application of double stapling technique in anus-preserving operation of low and middle rectal cancer

目的:探讨双吻合技术(double stapling technique,DST)在中低位直肠癌保肛手术(sphincter-reserving operation,SPO)中的应用价值及并发症的防治。方法:对比分析采用DST者32例(研究组)与采用单吻合技术者(single stapling technique,SST)43例(对照组)两组患者临床病理指标、术后并发症及肿瘤复发情况。结果:全组患者手术顺利,无手术死亡。两组患者在术后3个月和6个月时的排便功能比较差异有统计学意义(P<0.05),但1年后两组大部分患者排便功能基本正常。DST组术后发生吻合口瘘3例(9.38%),吻合口狭窄4例(12.5%),吻合口出血1例(3.13%),局部复发2例(6.25%);SST组术后发生吻合口瘘2例(4.65%),吻合口狭窄3例(6.98%),吻合口出血2例(4.65%),局部复发2例(4.65%)。结论:DST在中低位直肠癌手术治疗中是有效、安全的,能够提高中低位直肠癌保肛手术成功率,改善患者生存质量。

Objective：To study the clinical application and postoperative complication of double stapling technique （DST） in anus-preserving operation of low and middle rectal cancer. Method：From April 2002 to April 2006, clinical data of 75 cases with low and middle rectal cancer were analyzed retrospectively. Of those 32 cases used DST underwent sphincter-reserving operation（SPO）,regard as study group;and 43 cases used SST received SPO, as control group. Clinical pathologic parameters、 postoperative complication and tumor recurrence were compared between the two groups. Results：Operation of all the 75 patients was successful without operative mortality. In DST group patients, defecation function was different from SST group after postoperative 3 and 6 months （P〈0.05）, but defecation function of most of two group patients was basically normal after 1 year, and had no difference. In DST group postoperative complication included anastomotic leakage 3 patients（9.38%）, anastigmatic stricture 4 patients （12.5%）, anastigmatic bleeding 1 patient （3.13%）, local recurrence 2 patients （6.25%）;in SST group anastigmatic leakage 2 patient （4.65%）, anastomotic stricture 3 patients （6.98%）, anastomotic bleeding 2 patients （4.65%）, local recurrence 2 patient （4.65%）. Conclusion：The clinical application of DST was effective and safe in sphincter preserving operation of low and middle rectal cancer , enable to increase sphincter preserving operation achievement ratio, elevate patients quality of life.