弧形切割缝合器在直肠癌低位前切除术中的应用

目的:探讨新型弧形切割缝合器(凯途TM)在直肠癌低位前切除术中的应用.方法:回顾性分析2005年11月至2006年6月收治的46例低位直肠癌应用新型弧形切割缝合器施行低位前切除的临床资料.双重器械吻合前切除术40例中,1例家族性腺瘤样息肉病行全大肠切除回肠J型贮袋肛管吻合术;39例直肠癌,其中Dukes A期 11例,Dukes B期15例,Dukes C期13例,分别行低位或超低位前切除术、或前切除术.Hartmann术6例为5例Dukes D期和1例高龄体虚Dukes B期低位直肠癌.结果:双重吻合前切除40例中,超低位吻合33例(33/40,82.5%);无吻合口瘘发生,无局部复发出现;吻合口出血3例(3/40,7.5%),直肠阴道瘘2例(2/18,11.1%).行Hartmann术6例,直肠切割闭合处平均距肛缘2.8 cm.结论:弧形切割缝合器在低位直肠癌的保肛手术中的应用与直线形切割缝合器相比有着较大的优势.

The Application of the Curved Cutter Stapler in the Anterior Resection of Lower Rectal Cancer

Objective: To explore the application of a new stapling device (the Contour~ TM curved cutter stapler) in the anterior resection of lower rectal cancer. Methods: The clinical records of 46 patients with lower rectal cancer were analyzed retrospectively, who received lower anterior resection with the curved cutter stapler between November 2005 and June 2006. Results: Of the 40 cases who received double stapling technique (DST) anterior resection, 1 with familiar adenomatous polyposis underwent total colectomy and ileal J-pouch anal anastomosis; 39 with rectal cancer received low or ultralow anterior resection, or anterior resection. Of the 6 patients underwent Hartmann's procedure, 5 were with Dukes D stage disease and 1 was old and in poor health condition. Of 40 patients underwent DST anterior resection, 33 (33/40, 82.5%) were ultralow anastomosis. No anastomotic leakage and no local recurrence occurred. Anastomotic bleeding occurred in 3 patients and rectovaginal fistula in 2. In the 6 patients who received Hartmann's procedure, the average distance from cutting and closing line to anal verge was 2.8 cm. Conclusion: The curved cutter stapler is superior to linear stapler in the anus-preserving surgery of lower rectal cancer.