双吻合技术在中低位直肠癌保肛术中的应用

目的探讨双吻合器技术（double stapling technique,DST）在中低位直肠癌保肛手术中的应用价值。方法2002年8月-2008年2月53例中低位直肠癌,其中肿瘤距肛缘4-6cm13例,6-8cm20例,8-10cm20例,按全直肠系膜切除（total mesorectal excision,TME）原则,应用DST行保肛术。结果53例应用DST低位结肠-肛管吻合术均获成功,保肛率100%。手术时间120-180min,平均150min;术中出血量50-100ml,平均60ml;术后住院8-20d,平均10d。术后顺利恢复,吻合口发生渗漏1例,保守治疗20d愈合,发生率1.9%（1/53）;术后1年局部复发1例,复发率1.9%（1/53）。39例术后随访6-50个月,平均28个月,其中〉36个月20例,〉24个月32例,〉12个月36例,2例死亡,余37例均存活。结论DST治疗中低位直肠癌创伤小,保肛成功率高,可提高病人的生活质量。

Double Stapling Technique in the Management of Low Rectal Carcinoma

Objective To evaluate the value of double stapling technique （DST） in the treatment of low rectal anastomosis with the anus conservation. Methods In accordance with the principle of total mesorectal excision （TME） , from August 2002 to February 2008, we treated 53 patients with low rectal cancer by using the DST with the anus being conserved. Results All of the 53 patients were treated successfully with a anus conservation rate of 100%. The mean operation time was 150 min （120 -180 min） , and the mean blood loss during the surgery was 60 ml （50 - 100 ml）. The average postoperative hospital stay was 10 clays （8 -20 d）. One of the patients （ 1.9% ） developed anastomotic fistula after the operation and was cured by conservative therapies in 20 days. One patient （ 1.9% ） had local recurrence within 1 year postperation.. A 6-to 50-month follow-up was achieved in 39 patients （ mean 28 months, 〉36 months in 20 cases, 〉 24 months in 32 cases, 〉 12 months in 36 patients） , during the follow-up 2 patients died. Conclusions The DST is minimally invasivc for the treatment of low rectal carcinoma with high rate of anus conservation, and can improve the life quality of the patients.