经肛门拖出式切除并双吻合器技术在超低位直肠癌保肛术中应用.docVIP

经肛门拖出式切除并双吻合器技术在超低位直肠癌保肛术中应用 　 作者：张国虎，薛刚，曹永宽，王培红，张林，龚加庆 【摘要】 目的 探讨经肛门拖出式切除并双吻合器吻合在超低位直肠癌全直肠系膜切除术中的应用价值。方法 回顾性总结19例超低位直肠癌保肛手术的经验。结果 本组病例利用全直肠系膜切除技术，充分分离直肠并离断肿瘤近端后经肛门拖出，直线型闭合器切闭肿瘤远端，圆型吻合器行端端吻合，均成功保肛，术后病理检查残端无肿瘤遗留，发生吻合口漏1 例(5.3%) ，切口感染1 例(5.3%)，无手术死亡。结论 在全直肠系膜切除的基础上，经肛门拖出式切除并结合双吻合器技术行超低位直肠癌保肛术是安全可靠的，它可以大大提高超低位直肠癌保肛手术的成功率。 【关键词】 全直肠系膜；拖出式切除；双吻合器；超低位直肠癌；保肛 　　ABSTRACT Objective To discuss the application of pull out resection through anal canal with double stapling technique in total mesorectal excision for extra-low rectal cancer. Methods A retrospective review was made to 19 cases with extra-low rectal cancer treated by anus-conserving operation. Results Total mesorectal excision for rectal cancer was performed to all the 19 cases; the rectum was thoroughly separated, cut off at the proximal end and pulled out through anal canal; linear type closer was applied to close the distant end to the tumor; then end to end anastomosis was made with circular stapler, the anus was successfully conserved; pathological examination after operation showed no residual carcinoma in stumps; anastomotic leakage was found in 1 case (5.3%), incision infection in 1 case (5.3%), no death. Conclusions It is safe and reliable to apply pull-out resection through anal canal with double stapling technique in total mesorectal excision and it can greatly raise the successful rate of anus-conserving operation for extra-low rectal cancer. 　　KEYWORDS mesorectum resection with pull-through double stapler extra-low rectal cancer anus conservation 　　现代直肠癌外科治疗的一个显著特点是保肛手术的广泛应用，尤其是双吻合器技术的应用大大提高了超低位直肠癌(肿瘤距齿状线≤3 cm) 保肛手术的成功率。全直肠系膜切除( total mesorectal excision ， TME) 在临床的成功应用，更使下段直肠癌保肛率明显提高而局部复发率下降［1 ,2 ,3 ］ 。 2005年6月至2006年6月期间我科对19例超低位直肠癌患者实施TME、拖出式切除、双吻合器结肠肛管吻合术，疗效满意，报告如下。 　　1 临床资料 　　1.1 一般资料 本组病员19例，男性13例，女性6例，年龄41岁～75岁，平均年龄（56.2±11.2）岁。肿瘤距齿状线2cm～3cm，侵及肠壁1/ 2～3/4圈。病理类型：直肠中分化腺癌8例，中至高分化腺癌6例，低分化腺癌4例，息肉癌变1例。 　　1.2 手术方法 (1) 麻醉及体位：静脉复合麻醉，头低足高截石位。(2)手术过程：取下腹部正中切口入腹，常规探查，明确腹内脏器有无明显转移、肿瘤的