直肠全系膜切除下双吻合器在低位直肠癌保肛手术中的临床应用

目的]探讨直肠全系膜切除(TME)下行双吻合器(DST)在低位直肠癌保肛手术中的临床应用效果。方法]回顾性分析2009年1月～2011年1月某院收治的72例直肠癌患者,均应用全直肠系膜切除同时行双吻合器低位直肠前切除保肛手术的相关临床资料。结果]全组无手术闭合失败及手术死亡。本组中吻合口距齿状线≤2cm以内者8例,2～4cm30例,≥4cm以上34例。本组72例术后病理检查切除部位癌细胞阳性2例(2.8%)。本组术后发生吻合口狭窄1例(1.4%),伤口液化5例(6.9%),直肠阴道瘘1例(1.4%),吻合口出血3例(2.3%),术后出现吻合口漏4例(5.6%)。本组患者平均随访1.4年。术后1年后,72例患者其中局部复发5例(6.9%),无肛门失禁发生。结论]全直肠系膜切除联合双吻合器的应用符合肛门肛门功能,操作简单、经济,是治疗低位直肠癌的有效方法。

APPLICATION OF MECHANICAL ANASTOMOSIS IN TOTAL MESORECTAL EXCISION FOR LOW RECTAL CARCINOMA

Objective]To evaluate the value of total mesorectal excision(TME)and low colorectostomy formid low rectal carcinoma by applying them echanicalanastomosis.Methods]We retrospectively analyzed 326 children who had rectal carcinoma from January 2009 to January 2011.All the cases were according to the clinic data of TME and DST.Results]The mesorectum of all cases was cut completely and no one died in operation.The distance from stoma of anastomosis to the dentate line was less than 2 cm in 8 cases,2-4 cm in 30 cases and more than 4cm in 34 cases.The pathological masculine was 2.8%.Three cases were 1 cases(1.4%)stoma stenosis,5 cases(6.9%)of wound liquefaction,1 cases(1.4%)of vaginal fistula,3 cases(2.3%)of blood,4 cases(5.6%)of stoma divulge,and no cases of anus incontinence.Conclusion]It was worthy to be popularized for the advantages of convenient handling,economic cost and high anastomosis success rate of them echanical anastomosis after tumor resection according to TME principle.