超低位直肠癌保肛术中使用小口径吻合器的临床研究

Clinical Research of Small Caliber Stapler Applying in Anterior Resection of Ultra-Low Rectal Cancer with Anal Sphincter Preservation

目的探讨超低位直肠癌前切除术中应用小口径吻合器的安全性及优势。方法回顾性分析2006年6月至2009年6月期间我院普外科收治的60例超低位直肠癌患者的临床资料,均按TME原则行直肠癌双吻合器法前切除术。分别使用33mm口径吻合器和29mm口径吻合器进行吻合,每组各30例,对比分析2组患者术中、术后及预后情况。结果 33mm口径吻合器组术中单纯吻合时间为(9.0±3.3)min,29mm口径吻合器组为(6.0±2.6)min,2组比较差异有统计学意义(P=0.022 5);术中因损伤致吻合不良而需行吻合口修补者33mm口径吻合器组6例,29mm口径吻合器组2例,2组比较差异有统计学意义(P=0.030 1);2组的总手术时间,术后吻合口漏、狭窄、出血、复发、大便失禁的发生情况及住院时间差异均无统计学意义(P>0.05)。结论在超低位直肠癌前切除术中,使用29mm口径吻合器可以降低手术难度,缩短术中吻合口的吻合时间,但不增加术后吻合口狭窄及其他并发症的发生。

Objective To evaluate the safety and ascendancy of small caliber stapler application for anterior resection in ultra-low rectal cancer with anal sphincter preservation.Methods A retrospective analysis of the data of 60cases of ultra-low rectal cancer treated by anterior resection with anal sphincter preservation by double stapling technique according to TME principle between June 2006and June 2009were undertaken.The 60patients were divided into two groups,each group included 30cases.One group adopted 33mm stapler and another group adopted 29mm stapler,and then the profiles of medi-operation,post-operation,and prognosis were assessed.Results Time of simple anastomose in operation was（9.0±3.3）min in 33mm stapler group and（6.0±2.6）min in 29mm stapler group,and there was significant difference between them（P=0.022 5）.There were 6cases needed to be restored because of lesion during operation or dys-anastomosis in 33mm stapler group,while 2cases in 29mm stapler group,there was significant difference between them（P=0.030 1）.No significant differences were observed between the two groups in terms of the time for operation,leakage,bleeding,stenosis,anastomotic recurrence,and fecal incontinence after operation or length of stay.Conclusion The application of 29mm stapler not only can shorten time for anastomose and step down the degree of difficulty,but also dosen’t increase stenostomia and other complications.