腹腔镜缝合术在直肠癌超低位吻合术中的应用

The application of laparoscopic suturing technique in ultra low colo-rectal (anal) anastomosis of ultra low rectal cancer

目的:探讨腹腔镜缝合术在直肠癌超低位保肛治疗术中的应用及可行性。方法:按全直肠系膜切除术(total mesorectal excision,TME)原则,用腹腔镜对30例超低位直肠癌患者行TME超低位结肠、直肠(肛管)吻合术,其中用双吻合器(DST)手术17例,手工缝合直肠远端加吻合器手术13例。结果:手术均获成功,无中转开腹。平均手术时间双吻合器组190min(170～250min),缝合组270min(260～360min)。术中出血30～180ml,平均60ml;术后2d患者恢复胃肠功能并下床活动;平均住院11d(7～30d)。5例出现吻合口漏(DST组2例),均保守治愈。结论:腹腔镜缝合术用于直肠癌超低位吻合术是可行的。

Objective：To investigate the application and feasibility of suturing technique under laparoscopy with anal sphincter preservation in the treatment of ultra low rectal cancer. Methods：Excision of the mesorectum and ultra low colo-reetal（anal） anastomosis were performed by laparoscopy in 30 patients with ultra low rectal cancer based on the concept of TME, 17 patients with the double stapling technique （DST） and 13 patients with laparoscopic suturing technique. Results：Operations were performed successfully in 30 patients through laparoscopy. The mean operative time was as follows： DST group 190min（170-250min） , suturing group 270min（ 260- 360min ）. The mean blood loss was 60ml （30-180ml）. The time of bowel function recovery was about two days. The average hospitalization time was 11 days （ 7-30 days ）. 5 cases occurred anastmotic leakage （ DST group was 2 ）, they were cured eonservatiely. Conelusions：Laparoseopic suturing technique with anal sphincter preservation in the treatment of ultra low rectal cancer was feasibile.