全系膜切除加吻合器技术在中低位直肠癌保肛手术中的应用

Application of Mechanical Anastomosis in Total Mesorectal Excision for Mid-low Rectal Carcinoma

目的探讨全直肠系膜切除（total mesorectal excision，TME）＋吻合器技术在中低位直肠癌手术的应用效果。方法对103例中低位直肠癌患者实施TME原则的根治性手术，应用可重复管状消化道吻合器行低位结肠-直肠端端吻合术。结果103例均完整切除直肠系膜，无手术死亡，吻合口距齿状线4 cm以上46例，2-4 cm47例，2 cm以内者10例。均获随访，平均26（3-48）个月，术后发生吻合口漏1例，重置肛管引流一周治愈；吻合口狭窄3例，经定期扩肛后缓解；术后患者肛门括约肌功能良好。局部复发伴腹腔广泛转移6例（5.8%），死亡12例（11.7%）。结论TME术式基础上应用可重复弯管消化道吻合器行结肠-直肠低位吻合符合直肠肛门生理要求，具有操作简单安全，费用较低，吻合成功率高等优点，值得推广。

Objective To evaluate the value of total mesorectal excision（TME） and low colorectostomy for mid-low rectal carcinoma by applying the mechanical anastomosis.Methods Radical excision of mid-low rectal carcinoma was performed on 103 patients according to TME principle,and low colorectal end-to-end anastomosis was performed by applying the tubiform digestive-tract staplers.Results The mesorectum of 103 patients was cut completely and no one died in operation.The distance from stoma of anastomosis to the dentate line was more than 4cm in 46 patients,2～4 cm in 47 patients and less than 2 cm in 10 patients.Three patients were complicated by stenosis of colorectal stoma,which was relieved by periodically anus expanding.And one patient was complicated by anastomosis fistula,which was cured by anal conduction for a week.The functions of anal sphinter recovered smoothly after operation.6 cases occurred local recurrence and extensive metastasis,and 12 cases died later.Conclusion It is worthy to be popularized for the advantages of convenient handling,safety,economic cost and high anastomosis success rate of the mechanical anastomosis after tumor resection according to TME principle.