超低位结肠-肛管吻合术在低位直肠癌的应用(附87例报告)

Application of sustaining banding method for ultralow coloanal anastomosis with anal sphincter preservation after low rectal carcinoma resection

目的:探讨双吻合器套入式完整保留齿状线和肛门内括约肌的超低位结肠-肛管吻合术的应用。方法:87例低位直肠癌在完成全直肠系膜切除(TME)后,保留距离齿状线≤1cm的直肠,剥离直肠黏膜,保留齿状线,近端结肠内置入肛门支撑吻合管,经肛门拖出与直肠残端吻合。结果:87例保留内括约肌的超低位结肠-肛管吻合术无手术死亡及吻合口漏,随访2-60个月,随访率89%,无吻合口复发;盆腔内软组织肿瘤复发3例,闭孔淋巴结复发2例,异时肝转移6例。术后12个月吻合口狭窄6例。术后6个月对79例排便功能进行评价,平均每日排便2-3次,可以区分排气和排便,可以控制半成形便,排便不规律52例。结论:在盆底分离较低的情况下,套入法可以完成保留肛门内括约肌的超低位结肠-肛管吻合术。

Objective：To evaluate a new coloanal anastomosis preserving dentate line and anal sphincter. Methods：After total mesorectal excision in 87 patients with low rectal carcinoma, the rectum no more than 1 cm alcove the dentate line was preserved. The rectal mucosa was stripped and the dentate line was saved, then a sustaining anasto-motic tube was fixed into the proximal colon, and the colon was pulled down and anastomosed with the remnant rectum 0.5cm above the dentate line. Results：The uhralow coloanal anastomosis with anal sphincter preservation was accomplished. No perioperative death and anastomotic leakage occurred. The patients were followed up for 2 to 6 months and the follow - up rate was 89%. There was no anastomotic recurrence. Soft tissue recurrence in pelvic cavity was found in 3 cases, lymph node recurrence in obturator space recurrence in 2 cases and liver metastasis in 6 cases. Anastomotic stenosis was found in 6 cases two months later. The defecation function returned to normal six months after operation. Conclusion：The sustaining banding method in the ultralow coloanal anastomosis with analsphincter preservation is a safe and reliable surgical procedure.