敞开式缝吊荷包法在低位直肠癌保肛术中的应用

Application of Open-type Sewing Hanged Purse-string in Saving-anus Surgery for Low Rectal Cancer

观察敞开式缝吊荷包法在低位直肠癌保肛术中的临床应用效果，为低位直肠癌保肛手术提供一种方便有效的远端直肠荷包缝合法。对32例低位直肠癌患者采用敞开式缝吊荷包法行低位直肠癌保肛术治疗。按TME原则应用电刀锐性游离直肠至肛提肌水平，于直肠肿瘤下缘左右侧壁用4号丝线各缝扎一道作指示线。于指示线水平的直肠前壁开始边切边缝吊向左右侧切开直肠壁，至直肠后壁时将直肠壁与直肠系膜分离，将直肠系膜继续向远端游离5cm。完整去除直肠肿瘤和直肠系膜。提起远端直肠缝吊线，用荷包线于直肠断端作一锁边荷包。自肛门将32mm环状吻合器器身置入直肠，中心杆自直肠断端荷包中央突出，收紧荷包线后结扎。再次检查以保证吻合口内肠壁无多余脂肪组织后与放置于乙状结肠的抵钉座结合。此后按环状吻合器吻合操作常规行乙状结肠直肠端端吻合。结果32例手术均成功。除2例低分化腺癌外，在远切缘处未发现残留癌组织。术后无吻合口漏发生。所有患者术后3个月经结肠镜复查吻合口无肿瘤复发。结果表明，该法是一种可靠的低位直肠癌保肛术中远端直肠荷包缝合法，其优点：（1）既保证切缘无癌残留又可提高保肛成功率；（2）可保证完整去除肿瘤远端5cm的直肠系膜，达到TME标准；（3）减少吻合口漏的发生；（4）操作方便，出血少。

The aim of this study was to observe the clinical application of open-type sewing hanged pursestring in ano-saving procedure for low rectal cancer, so as to provide a convenient and effective method of remote rectal purse-string. According to TME principle, the rectum was sharp dissociated to the level of musculi levator ani with electric knife. Just at the lower edge of rectal cancer,with No. 4 thread two thread was transfixed at the left and right side as directionline. At the level of direction line, rectal wall was cut from the middle to left and right side and hanged by suture thread at the same time, up to the posterior wall, the mesorectum was easily separated from the rectum wall and was continued to be dissociated to provide free 5cm outward distal end. Rectal tumor and mesorectum were completely removed. Hanging the dis- tal rectal suture line and making a hemstitch purse-string at the rectal broken end. Put the 32ram circular stapler body into the rectum from the anus, protrude the center pole through the rectal stump purse-string, and then tighten the purse-string were taken. Thereafter ensure without more fat tissue in anastomotic leakage of intestinal wall, conneting propped nail seat in sigmoid colon, sigmoid colon-rectal end-end anasto- mosis was completed according to the conventional operation. Such open-type sewing hanged purse-string method had been successfully used in 32 patients with low rectal cancer. No residual cancer was found at the distal edge of anastomosis ring except two patients with poorly differentiated adenoearcinoma. Postop- erative anastomotic leakage did not occur. All the patients were reviewed by colonoscopy at 3 months after operation and no anastomotic tumor recurrence was found. Results indicate that open-type sewing hanged purse-string is a reliable method for the low rectal cancer,which has the following advantages： 1）not only guarantee no residual tumor at the cutting edge but also increase the success rate of anus saving; 2）ensure complete removal of the distal 5cm mesorectum from tumor to achieve TME standards; 3）reduce the incidence of anastomotic leakage; 4）easy to operate,less bleeding.