应用吻合器行直肠前切除术与直肠瓣的关系

Dixon's procedure using double stapling techniques and valves of Houston

目的:探讨直肠瓣(尤其是下直肠瓣)与直肠前切除术直肠的闭锁残端崩裂及吻合口渗漏关系。方法:5例成年男性的肛管直肠标本,对其直肠瓣进行了观测(其中两瓣3例,三瓣2例)。结果:①直肠瓣的数目,位置,发育程度变异很大;分布模式不甚恒定。②其长度,宽度,厚度及该处直肠管壁水平挤压厚度,垂直挤压厚度(即最大挤压厚度)分别平均为2.35cm,0.73cm,0.31cm,0.69cm,0.93cm。结论:应用闭合器/吻合器行直肠前切除术时,应当:①术前应尽可能了解病灶远端直肠瓣的分布模式,尤其是直肠下瓣的位置。②术中上闭合器时应尽可能避开直肠瓣或选择水平挤压位置(多半为矢状位),以获得较高的安全系数,避免闭合崩解。③吻合完成后则应在直肠瓣浆膜相应位置缝合数针以减少吻合渗漏发生率。

Objective: An attempt was made to study the relation between the Dixon ' s procedure using double stapling techniques and valves of Houston , mainly concerning the breach and leakage of anastomosis after rectal reconstruction . Materials: The valves of Houston was observed and measured on 5 adult male rectal specimens. Results : There is no consistency in the number of valves , position of the valves and sise of the folds. The average length of the valves was 2. 35cm ; the average breadth was 0.73cm and the width of the free edge was 0.31cm; The average thickness of rectum in site for valves of Houston in which squeezed horizentally and vertically (maximum thickness) were 0. 69cm and 0. 93 respectively. Conclusions When we have utilized double stapling techniques , we should know location of the valves of Houston , especially the lowest folds. Stapler should placed proper sites to avoid the valves of Houston and serosa of rectum in site for valves of Houston should consolidated with interrupted sutures so as to gain the law incidence of anastomotic leakage.