PPH钉合器在高龄中低位直肠癌手术中的临床应用

Clinical application of procedure for prolapse and hemorrhoids( PPH) stapler to mid-low rectal cancer operation in aged patients

目的探讨采用痔上黏膜环形切除（PPH）钉合器治疗高龄中低位直肠癌的可行性及安全性。方法对26例距离肛门2～7 cm,直径0.5～3.0 cm的直肠癌患者使用PPH钉合器行局部切除,对病灶组织进行连续病理切片检查,以确认切缘无癌细胞残留。结果 26例肿瘤切除率为100%,手术时间20～50 min,术后吻合口出血1例,无吻合口瘘和直肠周围感染。术后病理诊断：高分化腺癌13例,中分化腺癌9例,低分化腺癌4例。吻合口愈合良好,术后住院3～5（4.0±0.7）d。分别随访0.5～1年,2例于术后半年局部复发,再次采用PPH钉合器行局部切除;2例术后1年全身广泛转移,对症治疗后3个月内死亡;2例死于肺心病,2例死于高血压脑梗死;20例生存≥1年。结论 PPH钉合器治疗高龄中低位直肠癌是一种有效、安全、简便和术后并发症少的微创治疗方法。

Objective To explore the feasibility and safety of the procedure for prolapse and hemorrhoids（ PPH） stapler in mid-low site rectal cancer operation in aged patients. Methods 26 aged patients suffering from rectal cancers with the size of 0. 5 cm to 3. 0 cm in diameter locating 2 cm to 7 cm above the anal verge received local resection with PPH stapler in which continuous pathological sections were made to exclude the residues of cancer cell along the cutting edge. Results The successful rate of tumor resection was 100%; the operation duration lasted from 20 minutes to 50 minutes; anastomotic bleeding after operation occurred in 1case; no anastomotic leak or perianal infection was found; postoperative pathological study showed that out of the 26 cases,13 ones were well differentiated adenocarcinoma,9 moderate differentiated and 4 poor differentiated; the anastomosis healed well,and length of stay was 3-5 d（ averagely 4. 0 ± 0. 7 d）; follow-up lasted from 6 months to 1 year; 2 cases had reoccurrence and received the operation again; 2 cases suffered from extensive metastasis and died after symptomatic treatment for 3 months; 2 cases died of cor pulmonale and2 died of hypertensive cerebral infarcts; 20 survived for more than 1 year. Conclusions PPH stapler provides a simple,safe,effective micro-invasive therapy for aged patients with mid-low rectal cancer.