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目的：评价双吻合器技术在结直肠吻合尤其是低位结直肠吻合术中的作用。方法：回顾性分析自1995年5月至2002年5月间共计236例直肠癌应用双吻合器技术行结直肠吻合的经验。结果：全组术中直肠闭合和结直肠的吻合过程均顺利。术后发生吻合口瘘8例（3．3％），吻合口狭窄7例（2．5％），伤口感染2例（0．8％），无手术死亡。结论：双吻合器技术能帮助外科医生顺利完成以往手法缝合不易或难以完成的低位结直肠吻合术。     

低位直肠癌吻合器保肛术后靶向化疗的临床研究

目的 探讨国产吻合器吻合加靶向化疗在低位直肠癌治疗中的应用.方法 回顾性总结1990年1至2004年12月284例低位直肠癌应用国产吻合器行结直肠吻合,术后靶向化疗的经验.结果 所有患者均行保肛手术,术后2例发生吻台口瘘,发生率为0.8%.吻合口狭窄1例,发生率为0 4%.吻合口出血1例发生率为0.4%.切口感染5例,发生率为2.1%.术后复发率为1.7%(4/236).1、3、5年生存率分别为97.2%,86.9%,65.3%.全组无手术死亡.结论 国产吻合器在低位直肠癌保肛手术中是安全可靠的,可以帮助外科医生完成手法缝合难以完成的低位结直肠吻合术.     

双吻合器法在直肠癌保肛手术中的应用

目的：探讨双吻合器吻合法在直肠癌保肛手术中的应用价值。方法：回顾性总结我院1994－1999年52例直肠癌应用双吻合器法行结直肠吻合保肛的经验。结果：本组52例，应用双吻合器的直肠癌手术中直肠残端闭合失败2例（3．8％），吻合器切割不全4例（7．6％），术后发生吻合口漏2例（3．8％），吻合口狭窄3例（5．8％），切口感染2例（3．8％），吻合口出血1例（1．9％）。术后局部复发3例（5．8％），无手术死亡。结论：双吻合器在低位直肠癌保肛手术中是安全可靠的，可以帮助外科医生完成以往手法缝合难以完成的低位结直肠吻合术。     

应用双吻合器技术治疗直肠癌120例分析

目的评价双吻合器技术在结直肠吻合术尤其是低位结直肠吻合术中的应用。方法回顾分析自１９９４年以来在四年间治疗直肠癌,应用双吻合器行结直肠吻合术１２０例的经验。结果本组１２０例应用双吻合器的手术中直肠闭合和吻合进程顺利,术后发生吻合口瘘３例（２５％）,吻合口狭窄４例（３３％）,伤口感染２例（１６％）,无手术死亡。结论双吻合器技术能帮助外科医生顺利完成以往手法缝合不易完成或难以完成的低位结直肠吻合术。     

管状吻合器辅以荷包钳治疗直肠癌209例分析

目的评价吻合器辅以荷包钳技术在低位结直肠吻合术中的应用。方法回顾分析2000~2004年间治疗直肠癌应用吻合器辅以荷包钳进行结直肠吻合术209例的经验。结果209例应用荷包钳关闭远端直肠和吻合器结直肠吻合的进程顺利,术后发生吻合口漏4例(1.9%),吻合口出血3例(1.4%),吻合口狭窄3例(1.4%),术后病理切缘均阴性,无手术死亡。结论吻合器辅以荷包钳低位结直肠吻合技术能帮助外科医生为更多低位直肠癌病人进行保肛手术,且安全可靠。     

双吻合器技术在87例低位直肠癌前切除术中的应用

目的探讨双吻合器技术在低位直肠癌手术治疗中的应用价值。方法对1999年6月至2007年6月采用双吻合器技术治疗的87例低位直肠癌患者的临床资料进行分析。结果全组术中直肠闭合切割和直肠-乙状结肠吻合过程均顺利。术后发生吻合口漏5例（5.7%）,吻合口出血2例（2.3%）,伤口感染3例（3.4%）,吻合口狭窄4例（4.6%）,无手术死亡。结论双吻合器技术应用在低位直肠癌保肛术中是一种安全可靠的方法。     

弧形切割吻合器在低位直肠癌双吻合器技术中的应用

目的 评价弧形切割吻合器在双吻合器技术中的作用.方法 309例低位直肠癌患者分别采用弧形切割吻合器(弧形切割吻合器组,90例)及直线型闭合器(直线型闭合器组,219例)进行双吻合器吻合,对两组患者的术后保肛率及并发症进行比较.结果 弧形切割吻合器组保肛率(57.8%)高于直线型闭合器组(44.7%),两组比较,P＜0.05,差异有统计学意义.两组吻合口瘘、吻合口狭窄和吻合口出血发生率比较,P＞0.05,差异无统计学意义.结论 应用弧形切割吻合器可以提高低位直肠癌患者的保肛率.     

应用国产双吻合器行直肠癌保肛手术

目的探讨国产双吻合器在直肠癌保肛手术中的应用价值。方法回顾性总结我院1996年以来67例直肠癌患者应用国产双吻合器法行结直肠吻合保肛手术的经验。结果本组在直肠癌手术中应用双吻合器作直肠残端闭合均成功。吻合器切割不全4例,术后发生吻合口瘘2例(3.0%),切口感染2例(3.0%),吻合口出血1例(1.5%)。术后病理检查切缘癌细胞阴性65例,阳性2例。术后局部复发3例(4.5%),无手术死亡。结论国产双吻合器在低位直肠癌保肛手术中是安全可靠的,它可以完成以往手法缝合难以完成的低位结直肠吻合术。     

双吻合器技术在低位直肠癌前切除术中的应用

目的：评价双吻合器技术在低位结直肠吻合术中的应用。方法：回顾分析1996年5月至2003年5月治疗148例直肠癌应用双吻合器技术行结直肠吻合术的临床经过。结果：术后发生吻合口漏1例(0．68％)，吻合口狭窄2例(1．4％)，无手术死亡。结论：双吻合器技术扩大了保肛手术的应用范围。     

Dysplasia in the ileoanal pouch

Formation of an ileo‐anal pouch is an accepted technique following colectomy in the surgical management of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). The configuration of pouches and anastomotic techniques has varied over the last two decades. The increased use of stapling devices in formation of the pouch‐anal anastomosis avoids the need for endoanal mucosal stripping and may contribute to improved functional results, but leaves a ‘columnar cuff’ of residual rectal mucosa in situ. Concerns regarding the long‐term safety of the ileo‐anal pouch have been raised by reports of the occurrence of dysplasia in the pouch mucosa and 15 cases of adenocarcinoma. In UC, persistence of underlying disease in the residual rectal mucosa, anal transition zone and columnar cuff provides the site for development of dysplasia and malignancy. Pouchitis is unlikely to be a major cause of dysplasia or malignancy, as long‐term follow‐up of patients with Koch pouches has demonstrated. In FAP, any persistent rectal mucosa and mucosa of the small intestine is at risk of adenomatous dysplasia due to the genetic alterations causing the disease. Long‐term surveillance should focus on all FAP pouch patients, and in UC patients should be directed towards the diagnosis of residual rectal mucosa in the area distal to the pouch anastomosis. Specialist histopathological opinion is essential in the diagnosis of dysplasia in the ileo‐anal pouch.     

双吻合器技术在中低地位直肠癌保肛术中的应用98例报告

目的 探讨双吻合器技术在中低位直肠癌前切除术中的效果.方法 回顾分析2000--2005年间采用双吻合器技术治疗中低位直肠癌98例的临床资料.结果 98例手术后,吻合口漏5例(5.1%),吻合口狭窄4例(4.1%),局部复发6例(6.1%).结论 双吻合器技术的应用可以增加中低位直肠癌保肛的可能性,手术安全性好.     

The double stapling technique for low anterior resection. Results, modifications, and observations.

Since the introduction of the end-to-end anastomosis (EEA) stapler for rectal reconstruction, we have used a modification of the conventional technique in which the lower rectal segment is closed with the linear stapler (TA-55) and the anastomosis is performed using the EEA instrument across the linear staple line (double stapling technique). Our experience with this procedure includes stapled colorectal anastomoses in 75 patients and is the basis for the report. This review presents the details and advantages of the technique and the results. Complications include two patients with anastomotic leak (2.7%), and two with stenosis that required treatment (2.7%). Protective colostomy was not done in this series. There were no deaths. Our experience and that of others suggests that this modification of the EEA technique can allow a lower anastomosis in some patients, and that it can be done with greater safety and facility.     

Hirschsprung's disease: a possible cause of anastomotic failure following repair of intestinal atresia.

Despite several reported cases, the association of Hirschsprung's disease and intestinal atresia is not widely recognized. We describe three patients with jejunoileal atresia who all had a preoperative barium enema that failed to show a transition zone. All three patients developed an anastomotic leak of the atresia repair, and required a temporary diverting enterostomy. Two patients had total colonic Hirschsprung's disease and in one, the transition zone was in the midtransverse colon. Histological examination of the appendix at the time of repair may be helpful in patients with small intestinal atresia. In patients who develop an anastomotic breakdown, rectal biopsy should be performed to rule out Hirschsprung's disease.     

Management of Hirschsprung's disease in adolescents

It is unusual for Hirschsprung's disease to go undiagnosed until late childhood. Adolescents presenting with Hirschsprung's disease offer unique challenges to the surgeon because of the massively dilated and hypertrophied colon that is invariably present. Five adolescents (four males and one female; ages, 11 1/2 to 16 1/4 years) with newly diagnosed Hirschsprung's disease were managed by slightly different methods between January 1981 and March 1987. Three patients had a "leveling" colostomy, followed by a Swenson procedure in two and a Duhamel procedure with a temporary diverting colostomy in one. One patient had a primary Duhamel procedure with a temporary diverting ileostomy. One patient had a primary Swenson procedure without diversion. Long-term results were uniformly excellent. Based on the experience with these patients the following principles of management emerge: 1) Avoid loop "leveling" colostomies because of their grotesque size and their tendency to retract or prolapse. 2) Rectal tube decompression can often adequately prepare a patient for a primary pull-through procedure. 3) When a diverting ostomy is required, it should be an ileostomy rather than a colostomy because its subsequent closure will not endanger the marginal artery, which if divided, could compromise the blood supply to the pulled-through colon. 4) The Swenson procedure, although difficult in adolescents, can be done with excellent long-term results. 5) Several applications of the stapling instrument are required in the Duhamel procedure to fully divide the septum between the aganglionic rectum anteriorly and the normal colon posteriorly.     

应用手工缝合与单、双吻合器吻合行直肠癌前切除术疗效比较

目的探讨中低位直肠癌患者行结直肠吻合的方式及其疗效。方法 2006年1月～2011年12月行手术治疗的中低位直肠癌患者130例,其中行手工缝合者28例,单吻合器吻合49例,双吻合器吻合53例,采用病例对照研究回顾性分析三组的临床效果。结果三组患者手术均获成功,无围手术期死亡。单吻合器组和双吻合器组在手术时间、术中出血量上优于手工缝合组(P<0.05),但单、双吻合器组之间无统计学差异(P>0.05)。双吻合器组的住院费用远高于手工缝合组(P<0.05),但与单吻合器组比较无差异(P>0.05),手工缝合与单吻合器比较亦无差异(P>0.05)。而在吻合口瘘、吻合口狭窄、吻合口出血的发生率及住院时间方面,三组间比较无明显差异(P>0.05)。结论吻合器的使用能提高中低位直肠癌根治术时结直肠吻合的吻合效率,应首选使用;而手工缝合的并发症发生率也呈下降趋势。     

Trans-suture anastomosis. Choice of procedure in the management of colorectal anastomosis]

The double stapling technique was used to perform low anterior resection for rectal tumors in 122 patients (68 men, 54 women) with a mean age of 65 years (range, 28 to 87 years). There was no perioperative death. Technical problems related to the stapling technique and requiring transitory colostomy occurred in one patients. The clinical anastomotic leak rate was 5 per cent (six patients); in 2 patients, the fistula was treated successfully with a defunctioning transverse loop colostomy. Hospital stay ranged from 6 to 23 days (mean 10.2 days). Continence was normal in all patients at 6 weeks. One soft colo-anal anastomotic stenosis required dilatation. These results appear promising. The double stapling technique appears to facilitate low anterior resection of the rectum with safety.     

应用弧型切割吻合器的双吻合器技术治疗直肠癌52例

目的 评价应用弧型切割吻合器的双吻合器技术在结直肠吻合术、尤其是低位结直肠吻合术中的应用.方法 回顾分析2005年10月至2006年9月间应用双吻合器行结直肠吻合术治疗直肠癌52例的临床资料.结果 本组52例术中直肠闭合和吻合进程顺利,术后发生吻合口瘘1例(1.9%),吻合口出血2例(3.8%),直肠阴道瘘1例(1.9%),无吻合口狭窄,无手术死亡.结论 双吻合器技术能完成以往手法缝合不易完成的低位结直肠吻合术.     

凯途(CONTOUR)在低位直肠癌双吻合器技术中的应用

目的:评价CONTOUR在双吻合器技术中的作用.方法:回顾性分析2005年4月至2006年7月在低位直肠癌中应用的90例CONTOUR和219例XF进行双吻合器技术的比较.结果:CONTOUR组保肛率(57.8%)优于XF组(44.7%);吻合口漏、吻合口狭窄和吻合口出血等并发症两组无差异.结论:CONTOUR不增加并发症,能提高保肛率,是双吻合器技术中XF很好的替代产品.     

成人先天性巨结肠症的诊断和治疗

目的成人先天性巨结肠症的诊断和手术方法的探讨。方法对本院31例成人先天性巨结肠症的临床表现,诊断和手术方法,进行了回顾性分析。结果 29例行 Swenson 手术,1例 Duhamel 手术,术后并发吻合口瘘5例(16.7%)。早期吻合口狭窄2例,28例获得随访,完全恢复正常排便功能23例(78%),4例轻度排便失禁,1例完全排便失禁。结论成人巨结肠症手术后并发症较婴幼儿高。全结肠显著肥厚扩张时,保留回盲部的手术,术后并发吻合口瘘的发生率高;采用全结肠直肠切除回肠直肠末端吻合,并作预防性回肠造瘘术,可预防吻合口瘘的发生。     

Two-point rectal mucosal biopsy for selection of surgical treatment of Hirschsprung's disease

A two-point rectal mucosal biopsy (utilizing a histochemical study), namely biopsies at sites 5 to 10 mm and 30 to 50 mm oral to the dentate line, was developed to differentiate patients who can be treated adequately by rectal myectomy without colostomy and those who require other definitive surgery for Hirschsprung's disease. The examinations were performed in 28 patients suspected having a short aganglionic rectum. Ganglion cells were demonstrated by upper biopsy in four of 13 neonates, six of nine infants, and three of six children. These cases were successfully treated by rectal myectomy. The two-point rectal mucosal biopsy is useful not only for making definitive diagnosis but also for the selection of the surgical treatment for patients with Hirschsprung's disease.