凯途双吻合器对直肠癌低前切除术吻合口影响.docVIP

凯途双吻合器对直肠癌低前切除术吻合口影响 　 作者：宋新明 何裕隆 李明哲 练磊 詹文华 黄奕华 兰平 彭俊生 汪建平 【摘要】 目的 探讨凯途双吻合器吻合法对直肠癌低前切除术吻合口的影响。方法 回顾性分析总结122例直肠癌行直肠前切除并采用双吻合器重建肠道连续性的病例资料。结果 122例直肠癌患者中未行保护性转流造口，发生吻合器穿破闭合的远端直肠而以手工吻合2例；吻合口距齿状线距离为0.5～4 cm，平均2.5 cm。手术时间为185～260 min；术中出血量(327±53)mL。平均随访时间为13个月，发生吻合口漏2例（1.67％），经保守治疗好转。无吻合口狭窄、出血及吻合口周围感染发生，随访期内无局部复发。结论 在低位直肠癌行直肠前切除术中采用凯途双吻合器吻合，吻合口漏及吻合口狭窄发生率低，与手工缝合、荷包钳缝合相比可以缩短手术时间，减少术中出血量，达到超低位保肛，较直线型吻合器使用更方便，值得进一步推广应用。 【关键词】 直肠癌；直肠前切除术；双吻合法；凯途吻合器 Evaluation to the effect of CONTOUR stapler on the anastomosis in low anterior resection of rectal cancer [Abstract] Objective To assess the effectiveness of Contour stapler in double stapling technique (DST) on the anastomosis in low anterior resection of rectal cancer. Methods The consecutive data of 122 patients with rectal cancer underwent low anterior resection using DST with Contour from August 2005 to September 2007 in the First Affiliated Hospital of Sun Yatsen University were analyzed retrospectively. Results Among 122 cases, 120 cases got success anastomosis. The distance between the anastomosis and dentate line was about 0.5～4 cm (average 2.5 cm). Blood loss was 327±53 ml. The operation time was 3 hrs 5 mines to 4 hrs 20 mines. Staple lines of the distal rectum disrupted in 2 cases when circular stapler was placed, and then the anastomoses were made by suture. Protective colostomy was not performed in this series. Anastomotic leak occurred in 2 patients, but was cured by drainage and conservative treatment. The average time of followup was 13 months. There were no anastomotic stricture and local recurrence. Conclusion Our experience suggests that DST with Contour for low anterior resection of rectal cancer can allow a lower anastomosis with greater safety and facility. [Key words] Rectal cancer; Anterior resection; Double stapling technique; Contour stapler 结直肠癌的发病率仍正在不断上升。全球结直肠癌发病率平均每年递增2%。中国结直肠癌发病率的特点是直肠癌占结直肠癌的60%～70%，而低位直肠癌又约占全部直肠癌的70%。在直肠癌特别是低位直肠癌手术治疗方面，已不再满足于单纯的术后长期生存，对术后正常的生理功能和生活质量提出了更高的要求。吻合器械的进步特别是双吻合器的