圆形吻合器在中低位直肠癌保肛术中应用233例临床经验

Application of circular stapler in anal-preserving operation for middle or low rectal cancer:report of 233 cases

目的探讨圆形吻合器在中低位直肠癌应用的安全性和临床效果。方法对233例中低位直肠癌施行圆形吻合器吻合保肛术的临床资料进行分析。结果术后随访率86.3%(201/233),中位随访时间60.1个月。术后发生吻合口瘘11例(4.7%)均发生在术后4～12d,4例保守治疗痊愈,7例采用横结肠造口,3～4个月后还纳。吻合口狭窄6例(2.6%)多发生在术后2～6个月,经扩肛持续均解除。术后局部复发率为5.9%(12/201),复发时间为术后2～3年内。肝转移发生率为10.4%(21/201),多发生在术后2～3年内。中位生存时间60.1个月。术后5年生存率67.0%。结论圆形吻合器在中低位直肠癌保肛术中应用操作快捷、吻合可靠、方便安全,疗效满意。

Objective To investigate the safety and therapeutic effects of clinical application of circular stapler for middle or low rectal cancer.Methods Clinical data of 233 patients who had undergone anal-preserving operation for middle or low rectal cancer by using a circular stapler were analyzed retrospectively.Results Postoperative follow-up rate was 86.3%（201/233） with a median period of 60.1 months.Eleven patients developed stomal leakage（4.7%） within 4-12 days after operation.Among them,4 patients were cured by expectant treatment,7 received transverse colostomy followed by apothesis within 3-4 months.Six patients（2.6%） had stenostomia within 2-6 months,which was relieved by continuous anal expansion.Local recurrence rate was 5.9%（12/201）,while hepatic metastasis rate was 10.4%（21/201）.These occurred within 2-3 years after operation,with a median life span of 60.1 months and 5-year survival rate of 67.0%.Conclusions The application of circular stapler in anal-preserving operation for middle or low rectal cancer exhibited several advantages including operative safety and convenience,evidently reliable anastomosis with satisfactory outcome.