结直肠徒手一层缝合吻合与双吻合器技术在低位直肠癌保肛手术中的比较

Application of one-layer manual suturing and double stapling technique in sphincter-reserving operation for low rectal cancer

目的探讨结直肠一层缝合吻合法和双吻合器吻合法在低位直肠癌保肛手术中的应用效果。方法回顾性分析1998年1月至2007年1月间136例用一层缝合法进行吻合,210例用双吻合技术行保留肛门的低位直肠癌的临床资料。结果一层缝合法组无吻合口漏及狭窄,双吻合组吻合口漏发生率为1.4%,吻合口狭窄0.9%,均经保守治疗治愈。344例获得1～9年随防。一层吻合法组和双吻合器吻合组局部复发率分别为2.9%和3.3%,肝转移组3.7%和5.7%:肺转移1.4%和2.4%。一层缝合法组术后1、3、5年生存率分别为100%、82.5%、76.5%。双吻合组术后1、3、5年生存率分别为100%、81.4%、75.2%。结论双吻合技术具有操作简便易行、安全,术后并发症少、术后生活质量好,而一层吻合法价格低廉,在低位结直肠保肛术中有应用价值,值得临床推广。

Objective To evaluate the value of the one-layer manual suture and double stapling technique （DST） in sphincter-reserving operation for low rectal neoplasm. Methods The clinical data of 136 patients with low rectal cancer who underwent one-layer manual suture and 210 patients with low rectal cancer who underwent DST in sphincter-reserving operation from January 1998 to January 2007 were reviewed retrospectively. Results No stomal leak and anastomotic strictune occurred in the one-layer manual suture group. The local recurrence rate of the tumor was 2.9% , the incidence of liver metastasis was 3.7%, the incidence of pulmonary metastasis was 1.4% in the one-layer manual suture group . The postoperative oneyear survival rate, the three-year survival rate , the five-year survival rate were 100% ,82.5% ,76.5% respectively in the one-layer manual suture group. The incidence rate of stomal leak was 1.4%, the incidence of anastomotic stricture was 0.9% , the local recurrence rate was 3.3%, the incidence of liver metastasis was 5.73%, the incidence of pulmonary metastasis was 2.4% in the DST group. 334 patients were followed up from one year to nine years. The postoperative one-year survival rate, the three-year survival rate, and the five-year survival rate were100% , 81. 4% , 75. 2% respectively in the DST greup. Conclusions DSTis safe and convenient with few complications and quality of life after operation. One-layer manual suture technique is cheap and applicable in sphincter-reserving operation for low rectal neoplasm.