吻合器在低位直肠癌保肛术中的应用

目的：探讨吻合器在低位直肠癌保肛术中的使用方法及临床价值。方法：对2001年3月至2005年12月58例低位直肠癌术中应用吻合器保留肛门的病例资料进行分析。手术方法按照直肠癌根治性切除术及直肠系膜全切除术原则，切除近端肠管至少15cn，肿瘤下缘远端2era的直肠，应用吻合器在骶前行结一直肠端端吻合术以保留肛门。结果：全组病例均一次完成吻合，无1例手术死亡。吻合口狭窄2例、无吻合口瘘。随访1年～5年，复发2例。结论：应用吻合器在低位直肠癌术中保留肛门具有操作简单、方便、安全等优点，能提高患者的生存质量。     

双吻合器在低位直肠癌保肛手术中的应用

目的：评价双吻合器吻合技术在低位直肠癌保肛手术中的应用。方法：回顾性分析采用该技术行低位直肠癌保肛手术56例的经验。结果：56例吻合器切除圈定整。无吻合口漏、吻合口出前发生，无手术死亡。吻合口狭窄1例（1％），神经性膀胱排空障碍2例（3％），切口感染2例（3％）。结论：双吻合器吻合技术可以完成既往手法缝合无法完成的低位结肠直肠吻合术，最低位直肠癌保肛手术的理想术式。     

双吻合器在低位直肠癌保肛手术中的应用

目的　评价双吻合器吻合技术在低位直肠癌保肛手术中的应用。方法　回顾性分析采用该技术行低位直肠癌保肛手术 5 6例的经验。结果　 5 6例吻合器切除圈完整。无吻合口漏、吻合口出血发生 ,无手术死亡。吻合口狭窄 1例 (1% ) ,神经性膀胱排空障碍 2例 (3% ) ,切口感染 2例 (3% )。结论　双吻合器吻合技术可以完成既往手法缝合无法完成的低位结肠直肠吻合术 ,是低位直肠癌保肛手术的理想术式。     

国产吻合器用于中低位直肠癌保肛治疗67例临床观察

目的：为了探讨国产吻合器在中低位直肠癌保肛手术治疗中应用的可行性。方法：采用上海产GFI型管状消化道吻合器对67例中低位直肠癌患者行Dixon手术。结果：67例患者中，Ⅰ期愈合64例；吻合口瘘3例，均合并2型糖尿病。随访63例，随访时间15～36个月，无吻合1：3复发。控便功能满意，其中发生肝转移3例，盆腔复发1例。结论：国产消化道吻合器用于中低位直肠癌的保肛手术治疗简便、经济、安全、可靠，且效果满意，适宜于在基层医院推广应用。     

国产吻合器用于中低位直肠癌保肛治疗67例临床观察

目的:为了探讨国产吻合器在中低位直肠癌保肛手术治疗中应用的可行性。方法:采用上海产GF-Ⅰ型管状消化道吻合器对67例中低位直肠癌患者行Dixon手术。结果:67例患者中,Ⅰ期愈合64例;吻合口瘘3例,均合并2型糖尿病。随访63例,随访时间15~36个月,无吻合口复发,控便功能满意,其中发生肝转移3例,盆腔复发1例。结论:国产消化道吻合器用于中低位直肠癌的保肛手术治疗简便、经济、安全、可靠,且效果满意,适宜于在基层医院推广应用。     

改进的吻合器吻合术在低位直肠癌保肛术中的应用

端端吻合器（EEA）在低位直肠癌保留肛门的吻合术中，由于直肠残端荷包缝合仍较困难，与手法缝合相比，其总疗效差别不大，而双吻合器（DST）目前价格昂贵，推广应用受限。鉴于此，我们将端端吻合器的术式进行了改进，自1992年5月～1995年10月用国产GF－I型吻合器行改进的术式64例，现将治疗体会报告如下。1临床资料1．1一般资料64例中男30例，女34例；年龄29～75岁，平均48.4岁。高分化腺癌43例，低分化腺癌7例，粘液癌6例，乳头状腺癌8例。Dukes分期：A期36例，B期23例，C期5例。肿瘤下切缘距肛缘＜6cm27例，＜8cm37例。肿瘤切除后…     

三腔管在低位直肠癌保肛术后吻合口瘘防治中的应用

随着低位直肠癌保肛手术疗效逐渐被临床所公认和肯定 ,学者们研究出了多种保肛手术方法。作为低位直肠癌保肛手术后最常见并发症之一的吻合口瘘 ,临床效果仍不尽人意。自 1996年 10月以来 ,作者应用三腔管经肛门置入肠腔作为对 19例低位直肠癌保肛手术后吻合口瘘的防治方法 ,取得了一定效果现总结如下。1　临床资料本组男性 7例 ,女性 12例。肿瘤下缘距肛缘均在 8cm以下。其中行低位前切除 5例 ,经肛门翻出、超低位前切除 8例 ,经骶前径路直肠癌局部扩大切除 5例 ,经括约肌吻合 1例。在术后发生吻合口瘘的 8例患者中 ,除骶前常规置管引流外 …     

低位直肠癌保肛手术的改进

目的总结利用支撑管行低位直肠癌保肛术的经验和体会。方法对24例利用支撑管行低位直肠癌保肛术病例进行回顾性分析。结果全组病例顺利完成手术，术后出现吻合口漏1例，吻合口狭窄3例，随访时间平均80个月，局部癌复发2例。结论利用支撑管行低位直肠癌保肛术安全可行，具有良好的临床应用价值。     

双吻合器在直肠癌保肛手术中的应用

目的：探讨双吻合器在直肠癌保肛手术中的应用价值。方法：回顾性分析我院外科自１９９７年１月至１９９９年６月收治的３５例采用双吻合器行直肠癌保肛手术的病例。结果：全组吻合满意,切缘无癌残留,术后吻合口出血１例,直肠－阴道瘘１例,粘连性肠梗阻２例,切口感染４例,无吻合口狭窄。结论：双吻合的应用明显提高低位直肠癌保肛手术成功率,同时也是一种安全可靠的手术方式。     

用吻合器行直肠癌低位前切除术预防吻合口狭窄的体会(附30例报告)

在多种直肠癌保肛术式中 ,以低位前切除术功能疗效最好 ,尤其在吻合器运用后 ,扩大了前切除术的适应范围 ,其做术后并发症主要是吻合口狭窄及吻合口瘘。我科于 1996年 2月～ 1998年 8月用进口Ｐｒｏｘｉｍａｔｅ吻合器行直肠癌低位前切除术 30例 ,无一例发生吻合口狭窄和吻合口瘘 ,本文着重对吻合口狭窄防治的一些经验体会报道如下。1　资料和方法1.1　临床资料男性 18例 ,女性 12例 ;年龄 2 4～6 8岁间 ;肿瘤下缘距肛缘 5～ 7ｃｍ16例 ,8～ 9ｃｍ14例。高分化腺癌 3例 ,中分化腺癌 7例 ,低分化腺癌 2 0例。ＤｕｋｅｓＡ期 5例 ,Ｂ期 2 0例 …     

建立预测直肠癌术后前切除综合征的列线图模型

目的:分析腹腔镜直肠癌低位前切除术后发生前切除综合征（low anterior resection syndrome,LARS）的独立危险因素,并构建列线图预测模型。方法:采用回顾性病例对照研究,纳入并分析210例患者的临床病理资料。根据症状评分将患者分为LARS组和无LARS组,对临床资料进行单因素和多因素Logistic回归分析。将筛选出的LARS独立危险因素引入R软件,构建LARS发生概率的列线图预测模型。收集模型建立后的病例81例,采用时段验证法进行外部验证;模型的区分度通过计算C-index评价;模型的一致性通过计算校正后的C-index,并使用Hosmer-Lemeshow检验评价。结果:单因素分析中,新辅助治疗、体质量指数（BMI）、肿瘤下缘距肛缘距离、吻合口瘘与术后发生LARS相关;多因素Logistic分析显示新辅助治疗（P=0.003）、BMI≥30 kg·m-2（P=0.035）、肿瘤下缘距肛缘<5 cm（P＜0.001）和吻合口瘘（P=0.007）是LARS的独立危险因素;本模型C-index为0.808,校正后C-index为0.794;经Hosmer-Lemeshow拟合优度检验,预测模型与实际观察值之间无差异（χ2=3.368 1,P=0.909 2）。结论:肥胖、低位肿瘤,术前新辅助治疗,存在吻合口瘘的患者发生LARS的风险较高。本研究构建的列线图对术后发生LARS有较高的预测价值,可为个体化选择手术方式、制定治疗方案提供依据。     

Comparison of three-year oncological results after restorative low anterior resection,non-restorative low anterior resection and abdominoperineal resection for rectal cancer

IntroductionOncological outcome might be influenced by the type of resection in total mesorectal excision (TME) for rectal cancer. The aim was to see if non-restorative LAR would have worse oncological outcome. A comparison was made between non-restorative low anterior resection (NRLAR), restorative low anterior resection (RLAR) and abdominoperineal resection (APR).Materials and methodsThis retrospective cohort included data from patients undergoing TME for rectal cancer between 2015 and 2017 in eleven Dutch hospitals. A comparison was made for each different type of procedure (APR, NRLAR or RLAR). Primary outcome was 3-year overall survival (OS). Secondary outcomes included 3-year disease-free survival (DFS) and 3-year local recurrence (LR) rate.ResultsOf 998 patients 363 underwent APR, 132 NRLAR and 503 RLAR. Three-year OS was worse after NRLAR (78.2%) compared to APR (86.3%) and RLAR (92.2%, p < 0.001). This was confirmed in a multivariable Cox regression analysis (HR 1.85 (1.07, 3.19), p = 0.03). The 3-year DFS was also worse after NRLAR (60.3%), compared to APR (70.5%) and RLAR (80.1%, p < 0.001), HR 2.05 (1.42, 2.97), p < 0.001. The LR rate was 14.6% after NRLAR, 5.2% after APR and 4.8% after RLAR (p = 0.005), HR 3.22 (1.61, 6.47), p < 0.001.ConclusionNRLAR might be associated with worse 3-year OS, DFS and LR rate compared to RLAR and APR.     

直肠癌保留肛门术后局部复发原因及外科处理

Of seventy-one patients with rectal cancer after radical resection retaining the anus, 15 developed local recurrence with a recurrence rate of 21.1%. Local recurrence was correlated with improper safety margin from the lower edge of cancer to the anal end. There was statistical significant difference between 3 cm or more and 2 cm or less. The local recurrence was also related to the pathologic stage, histologic differentiation and implant of free cancer cells. It is suggested that the surgical indication of saving the anus be strict and without stretching, the safety margin from the lower edge of cancer to the anal end should not be less than 2 cm in early rectal cancer and not less than 4 cm in advanced lesions. During the operation, no touching tumor technique, thorough rinsing of the peritoneal cavity and pre- or post-operative radiotherapy are important for prevention of local recurrence. Early local recurrent rectal cancer can be detected by periodic examinations.     

直肠癌低位前切除术后肠功能改变的研究

直肠癌低位前切除术后,患者往往出现大便次数增多,大便失禁等排便功能障碍.研究表明,其功能障碍与新建直肠顺应性改变、肛门内括约肌功能损伤、内括约肌神经反射通路损伤、排便感觉变化等病理生理机制有关.     

超声刀在直肠癌超低位前切除术中的应用

目的探讨超声刀在直肠癌超低位前切除术中的应用效果。方法回顾性分析江苏省肿瘤医院2011年6月至2012年7月收治的行直肠癌超低位前切除术的64例临床资料。其中超声刀组36例,电刀组28例,两组均采用双吻合器法重建肠道。比较两组患者的手术时间、术中出血量、术中输血率、术后前3天引流量、术后肠功能恢复时间以及术后吻合口瘘发生率。结果超声刀组较电刀组手术时间、术中出血量、术后前3天引流量、引流时间均显著减少(均P<0.05);而术后肠功能恢复时间、术中输血率与术后吻合口瘘发生率则无统计学差异(均P>0.05)。结论超声刀在直肠癌超低位前切除术中应用效果较电刀更好。     

Comparison of abdominoperineal resection and low anterior resection in lower and middle rectal cancer

IntroductionThis study aimed to investigate local control and survival rates following abdominoperineal resection (APR) compared with low anterior resection (LAR) in lower and middle rectal cancer.MethodsIn this retrospective study, 153 patients with newly histologically proven rectal adenocarcinoma located at low and middle third that were treated between 2004 and 2010 at a tertiary hospital. The tumors were pathologically staged according to the 7th edition of the American Joint Committee on Cancer (AJCC) staging system. Surgery was applied for 138 (90%) of the patients, of which 96 (70%) underwent LAR and 42 were (30%) treated with APR. Total mesorectal excision was performed for all patients. In addition, 125 patients (82%) received concurrent (neoadjuvant, adjuvant or palliative) pelvic chemoradiation, and 134 patients (88%) received neoadjuvant, adjuvant or concurrent chemotherapy. Patients’ follow-up ranged from 4 to 156 (median 37) months.ResultsOf 153 patients, 89 were men and 64 were women with a median age of 57 years. One patient (0.7%) was stage 0, 15 (9.8%) stage I, 63 (41.2%) stage II, 51 (33.3%) stage III and 23 (15%) stage IV. There was a significant difference between LAR and APR in terms of tumor distance from anal verge, disease stage and combined modality therapy used. However, there was no significant difference regarding 5-year local control, disease free and overall survival rates between LAR and APR.ConclusionLAR can provide comparable local control, disease free and overall survival rates compared with APR in eligible patients with lower and middle rectal cancer.     

低位直肠癌保肛术后吻合口瘘防治

 【摘要】　目的　分析低位直肠癌保肛术后发生吻合口瘘的主要原因与防治措施。方法　回顾性分析1999年6月至2007年6月513例低位直肠癌保肛术后并发吻合口瘘23例患者的临床资料。结果　23例（4.5 %）发生吻合口瘘患者中20例（87.0 %）经非手术治疗痊愈，3例（13.0 %）并发腹膜炎行开腹处理后亦成功保肛。结论　低位直肠癌保肛术后吻合口瘘与术前胃肠道准备、Duke分期、合并糖尿病及术后早期腹泻等有关。诊断一经确定，积极采取三阶段疗法，多数患者可经保守治疗治愈。     

低位直肠癌保肛术后辅助放疗的价值

目的:探讨手术后辅助放射治疗对低位直肠癌保肛患者局部肿瘤复发的影响。方法:84例低位直肠癌保肛患者,分为单纯手术组和术后放疗组各42例。术后放疗组于术后半月行全盆腔常规方法分割照射治疗,照射总剂量为5000cGy。比较两组的局部复发率。结果:随访4年,术后放疗组和单纯手术组肿瘤局部复发率分别为14.3%和38.9%(P<0.05)。结论:对低位直肠癌保肛患者,术后进行辅助放疗有助于降低肿瘤局部复发。     

Laparoscopic intersphincteric resection for low rectal cancer

The goal of this review is to outline some of the important surgical issues surrounding the management of patients with low rectal cancer submitted to laparoscopic intersphincteric resection (ISR). Surgery for rectal cancer continues to develop towards the ultimate goals of improved local control and overall survival, maintaining quality of life, and preserving sphincter, genitourinary, and sexual function. Nevertheless, all progress in the development of oncologic therapy (i.e., radiation and chemotherapy), radical surgical removal of the tumour is the only chance for permanent cure of rectal cancer. Beside this main objective, the preservation of faecal continence is the second-most important goal to reach an acceptable quality of life with preservation of sphincter function. Information concerning the depth of tumour penetration through the rectal wall, lymph node involvement, and presence of distant metastatic disease is of crucial importance when planning a curative rectal cancer resection. Preoperative staging is used to determine the indication for neoadjuvant therapy as well as the indication for local excision versus radical cancer resection. In appropriate patients, minimally invasive procedures, such as local excision, TEM, and laparoscopic resection with ISR allow for improved patient comfort, shorter hospital stays, and earlier return to preoperative activity level. Data from small, non-randomized studies evaluating laparoscopic ISR suggest that this procedure is feasible by experienced surgeons. A literature search identified five studies [Uchikoshi F, Nishida T, Ueshima S, Nakahara M, Matsuda H. Laparoscope-assisted anal sphincter-preserving operation preceded by transanal procedure. Tech Coloprocto 2006;10:5-9; Bretagnol F, Rullier E, Couderc P, Rullier A, Saric J. Technical and oncological feasibility of laparoscopic total mesorectal excision with pouch coloanal anastomosis for rectal cancer. Colorectal Disease 2003;5:451-3; Rullier E, Sa Cunha A, Couderc P, Rullier A, Gontier R, Saric J. Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. British Journal of Surgery 2003;90:445-51; Watanabe M, Teramoto T, Hasegawa H, Kitajima M. Laparoscopic ultralow anterior resection combined with per anum intersphincteric rectal dissection for lower rectal cancer. Diseases of the Colon and Rectum 2000;43(Suppl. 10):S94-7; Miyajima N, Yamakawa T. Laparoscopic surgery for early rectal carcinoma. Nippon Geka Gakkai Zasshi 1999;100:801-5]. The aim was to find those studies that documented potential clinical application of laparoscopic ISR. These studies concluded that a laparoscopic approach can be considered in most patients with low rectal cancer in which laparoscopic ISR represents a feasible alternative to conventional open surgery. Hopefully, randomized controlled trials, which utilize these alternative procedures, will in future determine the results of laparoscopic ISR in terms of sphincter function, faecal continence, disease free and overall survival. The reviewed studies concluded that high quality and less invasive surgery could be achieved if ISR and laparoscopic surgery were combined.