经腹低位直肠癌切除结肠肛管吻合术的临床应用

198 0年 1月～ 1998年 10月共施行经腹直肠癌切除、结肛吻合术 33例 ,总结报道如下。1　临床资料1.1　一般资料　自 1998年 1月～ 1998年 10月对 33例低位直肠癌病人行经腹直肠癌切除 ,结肠肛管吻合术 ,其中男 2 0例 ,女 13例。年龄 2 3～ 74岁。肿瘤均位于腹膜返折平面以下。肿瘤大体类型 :溃疡型 2 9例 ,浸润型 4例 ;组织学上高分化腺癌 8例 ,中分化腺瘤 2 2例 ,低分化腺癌 2例 ,粘液腺瘤 1例。按改良Ｄｕｋｅｓ分期 ,Ａ期 18例 ,Ｂ期 8例 ,Ｃ14例 ,Ｃ2 2例 ,Ｄ期 1例 ,肿块下缘距肛缘 7～ 4ｃｍ ,主要以距肛缘 5～ 6ｃｍ为主 ,共 2 2例。…     

结肠肛管吻合治疗低位直肠癌(附23例报告)

23例低位直肠癌病人行结肠肛管吻合术(CAA),目的旨在评价CAA安全性、有效性及功能结果.肿瘤距肛门缘≤8cm20例(87％).7例(30％)属C期.切除肛侧断端无瘤边缘>2cm,23例均未作结肠造瘘,无手术死亡.吻合口漏3例(13％).21例功能评价,18例(85％)术后1年有良好自制力.23例随访生存率3年71.61％;5年63.65％.盆腔复发17％,无吻合口发.本文结果强调直肠低位肿瘤常规Miles术或未必明智,而CAA法能保留肛门自控能力乃为最佳选择.     

保留肛管人工成形结肠半月皱襞管扎式结肛吻合术用于低位直肠癌(附36例报告)

对３６例低位直肠癌病人应用支撑管行保留肛管人工成形结肠皱襞管扎式结肠肛管吻合术，疗效满意。本手术方法不仅达到根治的目的，同时保留了肛门括约功能，感觉反射及粪便储存功能，提高了病人的生存质量。该手术易操作，手术并发症低。３６例病人均得到随访观察，病人术后２～４个月内肛门括约肌功能均恢复到术前水平，除１例术后１１个月死于肝转移外，其余病人均健在，最长已生存６年以上     

经肛内外括约肌间切除术治疗超低位直肠癌的保肛效果观察

目的 探讨经肛内外括约肌间切除术(ISR)联合经腹全直肠系膜切除术(TME)及经肛结肠肛管吻合术治疗超低位直肠癌的保肛效果.方法 经肛ISR联合经腹TME及经肛结肛吻合术治疗34例无肛门外括约肌受侵的超低位直肠癌患者,术后进行肛门功能训练及功能评价.结果 34例患者远切缘距肿瘤下缘的中位距离为2.3 cm.病理类型为腺癌28例(其中高分化11例,中分化17例),乳头状癌1例,绒毛状腺瘤癌变5例.病理TNM分期Ⅰ期28例,Ⅱ a期1例,Ⅲa期4例,Ⅲb期1例.术后吻合口狭窄3例,吻合口裂开2例,直肠阴道瘘2例.术后早期肛门控便能力明显下降,术后6～12个月肛门功能逐渐恢复.术后5个月吻合口复发1例,术后40个月肝转移1例.结论 在严格掌握适应证的前提下,经肛ISR联合经腹TME及经肛结肠肛管吻合术符合肿瘤根治性原则,并保留了肛门功能,是一种超低位直肠癌保肛的有效手术方法.     

应用双吻合器在低位直肠癌保肛术中的改进及并发症的预防(附52例分析)

双吻合器是1993年引进国内的最新一代美国产直肠吻合器.本文结合作者在1997年1月至1999年2月应用双吻合器进行低位直肠癌保肛术的一些体会及技术改进,作一分析讨论.     

国产吻合器双荷包吻合在低位直肠癌保肛手术中的应用体会(附36例报告)

目的:探讨国产吻合器在低位直肠癌保肛手术中的应用.方法:对我院2005年4月-2008年4月在低位直肠癌根治术中应用国产吻合器双荷包结直肠吻合术36例的临床资料进行回顾性分析.结果:本组直肠离断、吻合过程顺利,术后发生吻合口漏2例,切口感染2例.无手术死亡病例.局部复发2例,均为Dukes C期,复发率为5.6%.4年生存率为89.9%.病人术后1个月内排便功能多数较差,6个月后趋于正常,无一例大便失禁.结论:对于肿瘤局限、分化良好、身体状况良好的低位直肠癌病人可以采用国产吻合器保肛手术,可以节约病人费用.     

直肠全系膜切除联合双吻合器在低位直肠癌保肛术中的应用(附32例报告)

目的评估直肠全系膜切除(TME)联合双吻合器在低位直肠癌保肛术中应用的安全性和实用性。方法回顾总结2006年5月至2010年5月32例低位直肠癌保肛术应用TME联合双吻合器的临床资料。结果所有患者吻合器切除圈完整。术后吻合口瘘2例(2/32,6.3%),神经性膀胱排空障碍2例(2/32,6.3%),切口感染3例(3/32,9.3%),吻合口出血1例(1/32,3.1%)。20例患者随访3～5年,3例肠粘连,1例吻合口狭窄,1例吻合口出血,1例因肿瘤转移死亡。结论 TME联合双吻合器在低位直肠癌保肛术中的应用安全可靠。     

低位直肠癌前切除术中吻合器的应用价值(附420例病例报告)

背景与目的：中同直肠癌的发病率逐年上升，如何提高患者的生存率及术中保肌是目前探讨的热点话题本研究旨在探讨直肠系膜全切除术（TME）及吻合器在低位直肠癌保肌手术中的作用、方法：回顾性分析邯郸市中心医院2000--2006年间420例低位直肠癌患者用吻合器行直肠癌前切除术的临床资料结果：全组手术进行顺利，无手术相关死亡，术后局部复发17例．占手术病例总数的4％。1年生存率为100％，5年生存率为63.1％。结论：低位直肠痛保肛手术中行TME及应用吻合器可明显降低局部复发率及提高患者生存率.     

全直肠系膜切除联合双器械吻合对低位直肠癌前切除术的临床分析(附75例报告)

目的　探讨在全直肠系膜切除的基础上 ,利用双器械吻合技术行低位直肠癌前切除术的可行性。方法　对 75例低位直肠癌行低位或超低位前切除吻合加直肠系膜全切除的治疗情况进行总结分析。结果　 75例中 ,低位吻合 17例 ,超低位吻合 5 8例 (77.3% ) ;全组无手术死亡 ,骶前出血 1例 ,吻合口瘘 1例 ,无吻合口狭窄。肿瘤下缘远切端肠壁癌残留 1例 ,复发转移 7例 ,全组病例 6个月内大便次数均在 5次 / d以下 ,3次以下者 5 5例 (73.3% ) ,无大便失禁。结论　在全直肠系膜切除的基础上 ,利用双器械吻合技术行低位直肠癌前切除术是安全可行的     

Anal sphincter preservation in locally advanced low rectal adenocarcinoma after preoperative chemoradiation therapy and coloanal anastomosis

BACKGROUND AND OBJECTIVES: Standard treatment of rectal adenocarcinoma located 3-6 cm above anal verge is abdominoperineal resection. The objective was to evaluate feasibility, morbidity, and functional results of anal sphincter preservation after preoperative chemoradiation therapy and coloanal anastomosis in patients with rectal adenocarcinoma located between 3 and 6 cm above the anal verge. METHODS: This study included 17 males and 15 females with a mean age of 54.8 +/- 15.4 years. Tumors were located at a mean of 4.7 +/- 1.1 cm above the anal verge. The mean tumor size was 4.6 +/- 1.5 cm. All patients received the scheduled treatment. Twenty-two patients underwent coloanal anastomosis with the J pouch; 10 underwent straight anastomosis. Average surgical time was 328.7 +/- 43.8 min, and the average intraoperative hemorrhage was 471.5 +/- 363.6 ml. The mean distal surgical margin was 1.3 +/- 0.6 cm. Five patients (15.6%) received a blood transfusion. RESULTS: Major complications included coloanal anastomotic leakage (three); pelvic abscess (three), and coloanal stenosis (two). Tumor stages were as follows: T0-2,N0,M0 = 12; T3,N0,M0 = 9; T1-3,N+,M0 = 9, and T1-3,N0-3,M+ = 2. Diverting stomas were closed in 30 patients. Median follow-up was 25 months. Recurrences occurred in four patients and were local and distant (n = 1) and distant (n = 3). Anal sphincter function was perfect (n = 20), incontinent to gas (n = 3), occasional minor leak (n = 2), frequent major soiling (n = 3), and colostomy (n = 2). CONCLUSIONS: In patients with locally advanced rectal cancer located 3-6 cm from anal verge who are traditionally treated with abdominoperineal resection, preservation of anal sphincter after preoperative chemoradiation therapy plus complete rectal excision with coloanal anastomosis is feasible and is associated with acceptable morbidity and no mortality.     

Preoperative treatment impact for ultralow rectal carcinoma sphincter preservation]

Sphincter preservation for low rectal carcinoma must be evaluated with a plurifactoriel approach. Multicentric randomised studies are unable to demonstrate a relationship between complete tumoral response and conservative sphincteric rate. Intersphincteric resection technique is becoming a main factor to transform conservative indication. Complete tumoral response should not be the only purpose of future trials.     

Functional outcome after intersphincteric resection of the rectum with coloanal anastomosis in low rectal cancer.

OBJECTIVES: Anterior rectal resection with partial removal of the internal sphincter is an option for low rectal cancer. The objective of this study was to evaluate the functional outcome after this intersphincteric rectal resection. METHODS: Anal continence was evaluated by anorectal manometry and a standardized questionnaire (Wexner Score) in 33 patients 28+/-15 weeks and 100+/-45 weeks, respectively, after intersphincteric resection. Nineteen of the 33 patients were reconstructed with a straight anastomosis; 12 received a colonic J-pouch. RESULTS: Post-operatively, 25.8% of the patients were incontinent to solid stool and 54.8% were incontinent to liquid stool at least once a week. Mean and maximum resting tone (24+/-10 and 40+/-13 mmHg), maximum tolerable volume (77+/-28 ml) and rectal compliance (1.4+/-1.2 ml/mmHg) were reduced in anorectal manometry. Squeeze pressures remained unchanged. Only the maximum tolerable volume correlated significantly with the continence score (r=-0.45, p<0.05). The Wexner score and maximum tolerable volume were significantly better after colonic J-pouch reconstruction than after straight anastomosis (9.9+/-4.5 vs 13.4+/-4.0, p<0.05, 65+/-20 ml vs 100+/-27 ml, p<0.01). CONCLUSION: Intersphincteric resection of the rectum leads to impaired post-operative continence. The functional outcome is improved with a colonic J-pouch.     

Complications of stapled anastomoses in anterior resection for rectal carcinoma: colorectal anastomosis versus coloanal anastomosis

Postoperative results of 48 patients who underwent anterior resection using the EEA-stapler were evaluated. In all but 2 cases the indication for surgery was colorectal carcinoma. In 24 patients an anastomosis was created above the 5 cm level (above the anal verge: colorectal anastomosis) and in 24 at the 0-5 cm level (coloanal anastomosis). There was no perioperative mortality. The only complication observed in the colorectal anastomosis group was one case of late anastomotic stenosis. In the coloanal anastomosis group there were 4 cases with early anastomosis leaks, 3 cases with late stenosis and 5 cases with various degrees of late fecal incontinence, ultimately resulting in a permanent diverting stoma in 5 (10.4%) patients. We conclude that for rectal tumors the EEA-stapled anterior resection provides excellent functional results in most cases. Stapled coloanal anastomoses more often demonstrate various (early and late) complications. Nevertheless in spite of chronic discomfort, many patients still prefer their complaints to a permanent stoma.     

新辅助治疗对低位直肠癌经内外括约肌间切除术后肛门功能的影响

  目的  进展期的低位直肠癌行新辅助治疗可明显降低局部复发,但是也可能会带来肛门功能的受损。本研究探讨新辅助治疗对经内外括约肌间切除术（intersphincteric resection,ISR）术后肛门功能的影响程度。  方法  选取2005年9月至2011年3月中国医科大学附属盛京医院103例行ISR手术的低位直肠癌患者,按照是否接受术前新辅助治疗分为CRT组（术前放化疗组）和对照组,通过向量测压、Saito功能问卷和Wexner评分来比较两组的肛门功能。  结果  CRT组的术前静息向量容积和收缩向量容积要明显低于对照组,术后两组的测压结果均显著下降,CRT组的所有指标均低于对照组（P < 0.05）。在6、12个月Saito功能问卷结果除排便困难两组间没有差异外,其余CRT组结果均明显不如对照组;在术后24个月,排便频率、排便截断、气便分辨能力以及限制饮食4项CRT组仍不及对照组（P < 0.05）。到术后24个月,两组Wexner评分均有下降趋势,CRT组高于对照组（P < 0.05）。  结论  对于需行ISR手术的低位直肠癌,新辅助治疗会明显的影响术后的肛门功能,而且这种影响要至少会持续2年时间。      

Anal Sphincter Function after Intersphincteric Resection for Low Rectal Cancer

Objective:To assess the anal sphincter function after intersphincteric resection for low rectal cancer by questionnaire and vectorial manometry.Methods:twenty five patients underwent intersphincteric resection,the controls contained 25 patients of rectal cancer who underwent low anterior resection and 25 healthy people.The therapeutic responses were evaluated using the Vaizey and Wexner scoring systems and vectorial manometry.Results:The Vaizey and Wexner scores after intersphincteric resection were significantly higher than those of low anterior resection controls at one month,but had no significant difference one year after.On the other hand,the indexes of vectorial manometry still had significant difference one year later.The indexes after intersphincteric resection could not reach the normal level.Conclusion:The anal sphincter function after intersphincteric resection is lower than that after low anterior resection in short term,although the long-term results can be accepted,it still can not reach the normal level.     

腹腔镜辅助括约肌间切除超低位直肠癌保肛手术的疗效研究

目的评价腹腔镜辅助括约肌间切除(ISR)超低位直肠癌保肛手术的可行性和安全性。方法回顾性分析2008年10月至2011年9月在我院实施的连续30例超低位直肠癌腹腔镜ISR手术的临床资料,与同期30例行开腹ISR手术患者进行比较,比较两组患者围手术期情况、肿瘤安全性、术后排便功能及近期疗效。结果腹腔镜组均行全直肠系膜切除(TME),且完全保留盆腔自主神经,没有中转开腹病例,中位手术时间213min,中位出血量80ml,术后中位住院时间14d,术后并发症9例(9/30),其中8例是肛周粪渍性湿疹,1例结肠黏膜脱出。与开腹手术组患者比较,腹腔镜手术组时间较短,出血量较少,住院时间较短,差异有统计学意义,并发症发生率无显著性差异。两组患者术后肛门排便功能以及直肠肛管测压结果无显著性差异。两组患者肿瘤安全性方面无显著性差异,中位随访时间17个月,两组均无局部复发、远处转移,全部患者无瘤生存。结论超低位直肠癌行腹腔镜ISR保肛手术技术上是可行的,短期疗效满意,是一种微创、安全的可供选择的保肛手术方法。     

改良结肠肛管吻合术治疗低位直肠癌

目的探讨改良结肠肛管吻合术在低位直肠癌治疗中的价值。方法回顾分析37例低位直肠癌的术后并发症及疗效。结果术后发生吻合口瘘2例,吻合口狭窄9例,无手术死亡和肛门失禁;盆腔复发5例。结论改良结肠肛管吻合术在保留肛门功能的同时,避免了预防性横结肠造口,其局部复发率与低位前切除和经腹会阴切除相似。     

改良结肠械管吻合术治疗低位直肠癌

目的探讨改良结肠肛管吻合术在低位直肠癌治疗中的价值。方法回顾分析37例低位直肠癌的术后并发症及疗效。结果术后发生吻合口瘘2例,吻合口狭窄9例,无手术死亡和肛门失禁;盆腔复发5例。结论改良结肠肛管吻合术在保留肛门功能的同时,避免了预防性横结肠造口,其局部复发率与低位前切除和经腹会阴切除相似。