腹腔镜器械切割缝合器在直肠癌低位保肛术中的应用

目的 探讨腹腔镜器械切割缝合器(ATP45)在直肠癌低位保肛术中应用的方法和效果.为提高低位直肠癌保肛率探索新的吻合方法.方法 回顾性分析17例低位直肠癌患者应用ATB45,在全直肠系膜切除(TME)的基础上完成保肛手术.结果 低位前切除术5例,超低位前切除术12例.ATB45切割、吻合直肠肠壁满意,断端出血少.患者恢复顺利,无吻合口瘘、吻合口出血等情况发生.结论 腹腔镜器械切割缝合器行低位直肠癌保肛手术,使双吻合器技术更加方便,矿大了低位直肠癌保肛手术的适应证范围,安全可亍.

Laparoscopic cutting-stitching instrument(ATB45) in anus-preserving operation for low rectal cancer

Objective The aim of this study was to assess the feasibility and ef-ficacy of total mesorectal excisicon with anal sphincter preservation using laparoscopic cutting-stitching instrument (ATB45).Methods Seventeen patients with low rectal cancer underwent total mesorectal excision with ATB45 were retrospectively analyzed.Total mesorectal excision was followed by high ligation of the inferior mesenteric artery close to its origin .Then the rectum add its mesentery were sharply dissected under di-rect vision,ensuring en bloc resection of the mesorectum.The rectum loop was excised 2-3cm below the tumor inferior margin with ATB45.Colo-rectal or colo-anal anastomosis was done with a SDH33 circular stapler.Results The age of all patients ranged from 17 to 67 years(mean 53.5 years ).Preoperative biopsy revealed malignant rectal tumors in all patients.The lowest edges of the tumors were within 7cm from the anal verge(< 5 cm in 12 patients,and 5-7 cm in 5).Dukes stages were A:3 patients,B:3,C:7,D:4.Five patients underwent low anterior resection,whereas the other 12 patients under-went ultra low anastomosis.Rectectomy using ATB45 was satisfactory with less bleed-ing.No anastomotic leakage or hemorrhage occurred in all patients.Only few patients suffered from urgent defecation about 6 times per day, and their defecation was controlled gradually to 4 times per day in 3 months.Four patients had diarrhea and con-stipation alternately.Conclusion Low rectal cancer resection with ATB45 is a feasi-ble,safe and convenient technique with few postoperative complications.Furthermore,it extends the range of the indications for anal sphincter preservation.