支撑捆扎法在腹腔镜下全直肠系膜切除超低位结肠-直肠/肛管吻合术中的应用

Application of the sustaining-binding technique in laparoscopical total mesorectal excision and ultralow colorectal/anal anastomosis

目的 介绍支撑捆扎法在腹腔镜下对低位直肠癌进行全直肠系膜切除(TME)超低位结肠-直肠/肛管吻合的手术方法。方法 应用超声刀在腹腔镜下对11例低位直肠癌患者实施TME原则的根治性切除,用支撑捆扎法完成超低位结肠-直肠/肛管吻合术。结果 11例患者术中直肠系膜切除完整,超低位结肠-直肠/肛管吻合成功,吻合时间15～30 min;吻合口距齿状线小于2 cm 8例,结肠与齿状线处肛管吻合的3例。术后恢复顺利,肛门括约肌功能、排尿功能良好,未发生吻合口瘘与吻合口狭窄。结论 腹腔镜结合支撑捆扎法可以对低位直肠癌行TME切除后进行超低位结肠-直肠/肛管吻合术。

Objective To investigate the method of laparoscopic total mesorectal excision(TME) and ultralow colorectal/annl anastomosis for rectal cancer by applying the sustaining-binding technique. Methods Radical excision of low rectal cancer was performed laparoscopically with harmonic scalpel on 11 patients based on the concept of TME and uhralow colorectal/anal anastomosis was performed by applying the sustaining-binding technique. Results Eleven ultralow colo rectal/anal anastomosis was successfully completed laparoscopically and the anastomosis time was 15～30 min. The mesorectum was cut completely. The distance from stoma to the dentate line was less than 2 cm in 2 patients and colo anal anastomosis was performed in 1 patients. The function of anal sphincter and micturition recovered smoothly after the operation without anastomotlc stoma leakage and anastomotic stoma stenosis. Conclusions Laparoscopic total mesorectal excision with harmonic scalpel for low rectal cancer has a characteristic of radical excision. Ultralow colorectal/anal anastomosis can be performed completely by applying the sustaining-binding technique, which is a new perspective technique of sphincter preservation.