器械吻合联合全直肠系膜切除在保肛手术中的应用

Application of double stapling technigue combined with total mesorectal excision for anuspreservation operation on low position rectal cancer

目的 探讨双器械吻合技术联合全直肠系膜切除在低位直肠癌保肛手术中的应用方法和临床疗效。 方法 在全直肠系膜切除的基础上 ,应用双器械吻合技术 ,对 5 3例低位直肠癌行低位或超低位吻合 ,随访 3年 ,回顾性分析其根治性、术后排便功能 ,手术并发症 ,局部复发率。 结果 低位吻合 12例 ,超低位吻合 41例 ;无切端癌残留 ;6个月内大便次数 5 -10次 /d 18例 ,6个月后大便次数均在 5次 /d以下 ,无大便失禁。无吻合口漏 ,吻合口狭窄发生率 3 8% (2 /5 3 ) ,全组无手术死亡 ;肿瘤局部复发率 5 6% (3 /5 3 )。 结论 在全直肠系膜切除基础上 ,利用双器械吻合技术行低位直肠癌保肛手术是保持排便功能 ,减少并发症 ,减少局部复发 ,提高生活质量的有效方法。

Objective To investigate the specific method and therapeutic yield of application of double stapling technigue combined with total mesorectal excision for anuspreservation operation on low position rectal cancer. Methods Using DTS combined with TME, 53 cases of low position rectal cancer operated with low or ultralow colonrectum anustomosis were analyzed, including the radical cure effect and theoperative mergencesymptom and the function of excereting feces.The cases were followed for 3 years. Results 12 cases were performed on with low colonrectum anastomosis,41 cases were performed on with ultralow colonrectum anastomosis,There was not tumor remaining. There was no operation death,leakage of anastomotic opening and incontnence of feces in the group. Two patients suffered from narrowness of anastomotic opening. Local recurrence rate was 5.6%(3/53) in the follow up period. Conclusion Total mesorectal excision combined with double stapling technique is not only an effective method to maintain function of excereting feces in lower rectal cancer,but also to improve the living quality of patients and reduce local reccurence.