超低位直肠癌全直肠系膜切除肛缘吻合术15例临床的的体会.docVIP

超低位直肠癌全直肠系膜切除肛缘吻合术15例临床的的体会 　　【摘要】 目的 探讨超低位直肠癌全直肠系膜切除肛缘吻合术的方法。方法 本组15例，其中男 10 例，女5例。年龄47~72岁，平均56.3岁；其中高分化腺癌 4例、中分化腺癌7例，腺瘤恶变4例。CEA水平升高8例，正常水平7例。术前腔内B超提示癌肿均未超过浅肌层，未形成环肠腔生长。Dukes分期均为B期。采用全直肠系膜切除肛缘吻合术。结果 所有15例患者均未出现吻合口瘘和个肛门狭窄，9例患者因术后肛门排便疼痛于1个月后在骶麻下摘除吻合器钉。术后均有便意和排便感觉。全部病例随访3~6个月，排便次数≤3次11例，≤5次4例。结论 超低位直肠癌Dukes分期不超过B期的病例实行直肠癌全直肠系膜切除肛缘吻合术是一种有效的保肛方法。 　　【关键词】超低位直肠癌 全直肠系膜切除 肛缘吻合 　　中图分类号：R735.37文献标识码：A文章编号：1005-0515（2010）11-047-02 　　The ClinicalExperienceofUltra Low Cance Total Mesorectal Excision Anal Verge Anastomosis 　　DANG Yi XU Zhe 　　(Department of General Surgery,Affiliated Xinhua Hospital Of Dalian Univercity，Dalian116021) 　　【Abstract】Objective To explore the method of ultra low cancer total mesorectal excision Methods There are 15 cases in this group,10 males and 5 females. Between 47 to 72 years old,average age is 56.3;This group have 4 cases of tubular carcinoma,7 cases of medium differentiated adenocarcinoma,4 cases of adenoma transforming. The levels of CEA was increased in 8 cases,7 cases are normal. Intravaginal ultrasound correlated the tumor didn’t pass the of superficailmuscle and not grow around the ultra. All of these cases are Dukes stages B. Use totalmesorectal excision anal verge anastomosis. Results All of 15 patients didn’t have astomotic leakage and stricture of anus;9 patients drop the stapler nail under the caudal anesthesia after a month because of anastomosis pain in defecation. All of patients have feel of defecation after operation. All of them follow-up 3-6 monthes, 11 patients defecation no more than 3 times ,4 patients no more than 5 times. Conclusion The operation of total mesorectal excision anal verge anastomosis to ultra low cancer which Dukes stages don’t pass B is a effective anal sphincter preserving methods. 　　【Keywords】Ultra low cancerTotal mesorectal excisionAnal verge anastomosis 　　 　　直肠癌是临床常见的恶性肿瘤之一，超低位直肠癌并不少见，一般指距离齿线4cm以内的肿瘤，以往大多行经腹会阴联合切除术（Miles术），我科从2003年7月~2008年4月对15例Dukes B期的超低位直肠癌行全直肠系膜切除肛缘吻合术，效果满意，现总结如下： 　　１ 资料与方