全直肠系膜切除支撑捆扎法低位或超低位结肠-直肠(肛管)吻合术  

Total mesorectal excision and low/ultra-low colo-rectal(anal) anastomoses with sustaining bonding method in the treatment of lower rectal cancer

作　　者：韩方海[1] 詹文华[1] 张肇达[2] 

机构地区：[1]中山大学附属第一医院胃肠胰外科,广州510080 [2]四川大学华西医院普通外科

出　　处：《中华普通外科杂志》2005年第7期403-405,共3页Chinese Journal of General Surgery

摘　　要：目的介绍在全直肠系膜切除基础上用支撑捆扎法完成低位直肠癌低位或超低位结肠-直肠(肛管)吻合手术术式.方法对346例低位直肠癌在全直肠系膜切除和根治性清扫基础上,用支撑捆扎法进行保留肛门括约肌手术,对直肠断端距齿状线≥1 cm者用改良Welch手术完成结肠-直肠吻合术;直肠断端距齿状线≤1 cm者行保留肛门内括约肌的结肠-肛管吻合术.结果本组346例手术中无死亡病例,术后近期出现吻合口漏4例(1.2%),局部引流2周治愈2例、横结肠造口转流2例,无吻合口出血.吻合口距离齿状线距离:2～3 cm者114例,1～2 cm者145例,0～1 cm者87例.术后吻合口狭窄10例,狭窄率2.9%.Life table法计算5年生存率和局部复发率分别为78.6%及6.3%.手术后3个月排便功能的优良率为82.6%.结论支撑捆扎法用于低位直肠癌保肛手术可以完成耻骨直肠肌上缘到肌间沟平面的吻合,吻合口漏和吻合口狭窄发生率较低.Objective To evaluate a surgical procedure of low/ultralow colo-rectal （anal） anastomoses with sustaining bonding method after total rnesorectal excision （TME） for lower rectal cancer. Methods After TME in 346 eases of lower rectal carcinoma, a sustaining anastomotic tube was inserted into the proximal colon, then the remnant was ligated and sutured. The rectal remnant no less than 1 cm was preserved by colo-rectal anastomoses of modified Welch operation, while the rectal remnant no more than 1cm were preserved by colo-anal anastomoses with anal sphincter preservation. Results There was no perioperative mortality. Anastomotic leakage developed in 4 cases （ 1.2% ）, and anastomotic stenosis in 10 （2. 9% ）. Postoperative 5 year survival and recurrence was 78. 6% , 6. 3% respectively. The defecation function was satisfactory in 82.6% cases. Conclusions Low/ultra-low colo-rectal （anal） anastomoses with sustaining bonding method after TME is safe and effective for lower rectal cancer.

关 键 词：全直肠系膜切除术 支撑捆扎法 低位 超低位 结肠-直肠吻合术 肛管 

分 类 号：R735.37[医药卫生—肿瘤]