单双吻合器联合全直肠系膜切除在中低位直肠癌保肛手术中的应用

目的:探讨单双吻合器吻合法联合全直肠系膜切除(TME)在低位直肠癌保肛手术中的应用价值。方法:回顾性分析我院自2002年以来应用单、双吻合器吻合法联合TME治疗中低位直肠癌246例临床资料。结果:本组病例行单吻合器吻合149例、双吻合器吻合97例,整个手术进程顺利,术中大出血2例(0.8%),术后发生吻合口漏8例(3.3%),其中直肠阴道漏2例(0.8%),吻合口狭窄9例(3.7%),吻合口出血4例(1.6%),切口感染15例(6.1%),术后切口裂开3例(1.2%),术后肛门坠胀不适57例(23.2%),局部复发9例(3.7%),肝脏转移10例(4.1%),腹腔广泛转移4例(1.6%)。结论:单双吻合器与TME联合应用是治疗中、低位直肠癌有效、安全的术式,不仅能够降低术后局部复发率,而且还可改善患者生存质量,提高生存率、保肛率。

Clinical application of single and double stapling technique for total mesorectal excision in anus-preserving operation of middle or low rectal carcinoma

Objective:To evaluate the clinical application of single and double stapling technique for total mesorectal excision(TME) in anus-preserving operation of middle or low rectal cancer.Methods:The clinical data of 246 patients with middle or low rectal cancer were gathered from 2002 to 2006 for this retrospective study and all of the cases were experienced with single and double stapling technique for TME.Results:In all 246 patients,the single stapling for TME was used in 149 patients,and the double stapling,in 97 patients.Successful operation was achieved except for complications as massive haemorrhage during the operation in 2 patients(0.8%),anastomotic fistula in 8(3.3 %),including 2 cases of rectum-vaginal fistula(0.8%).Other complications such as anastomotic stenosis developed in 9 patients(3.7%),anastomotic bleeding in 4(1.6%),wound infection in 15(6.1%),wound rupture in 3(1.2%),anus discomfort in 57(23.2%),local recurrence in 9(3.7%),liver metastasis in 10(4.1%) and celiac wild metastasis in 4 cases(1.6%).Conclusion:The clinical application of single and double stapling technique for TME can be safe and effective in anus-preserving operation of middle or low rectal carcinoma,which may not only reduce local recurrence rate,but improve the quality of patient's life and even survival and anus-preserving rate.