镍钛记忆合金加压吻合夹在晚期癌性肠梗阻短路吻合中的应用

Application of Compression Anastomosis Clip for Bypass Anastomosis in Operation of Advanced Malignant Intestinal Obstruction

目的探讨新型镍钛记忆合金加压吻合夹在晚期癌性肠梗阻短路吻合中运用的安全性及有效性。方法选取2006年4月～2008年3月我科41例需行小肠短路或回结肠短路术的晚期癌性肠梗阻患者,随机分为两组,加压吻合夹(CAC)组使用CAC进行吻合;手工缝合组采用手工缝合法进行吻合。观察手术时间、肠吻合时间、术后并发症发生率、肛门排气时间以及CAC排出时间。结果 CAC组手术时间、肠吻合时间、术后并发症发生率及住院时间均少于手工缝合组,两组之间差异具有统计学意义(P<0.05),两组各死亡1例,但均与手术操作无关。两组术后均未发生吻合口梗阻,两组术后肛门排气时间差异无统计学意义(P>0.05)。CAC组CAC均于术后10～18d排出体外。结论应用CAC对晚期癌性肠梗阻行短路吻合安全可靠、使用简便,值得临床推广应用。

Objective To evaluate the safty and efficacy of compression anastomosis clip（CAC） for bypass anastomosis in the operation of advanced malignant intestinal obstruction.Methods Forty-one patients who underwent intestinal bypass anastomosis or ileocolostomy between Apr 2006 and Mar 2008 were assigned randomly to use either CAC or manual suture. CAC group underwent intestinal bypass anastomosis or ileocolostomy with CAC, while manual group underwent intestinal bypass anastomosis or ileocolostomy with manual suture. The following parameters have been recorded： operative time; intestinal anastomosis time; anastomotic complication; first post-operation flatus and bowel movement; extrusion of clip device.Results The operative time,intestinal anastomosis time,the occurrence rate of postoperative complication and hospital stay in CAC group were all less than that in manual group,and the differences between two groups showed statistical significance（P0.05）. One mortality was recorded in each group, but were not related to anastomotic procedure. Two groups had the similar results in recovery of bowel function（P0.05）.The clip is expelled with the stool within 10~18 days.Conclusion It is safe and simple to use CAC for bypass anastomosis in the operation of advanced malignant intestinal obstruction, and CAC can reduce the trauma and pain, and improve the quality of life. This operation may be generally applied in clinical practice.