低位直肠癌保肛手术中弧形切割缝合器的应用体会  

Application of curved cutter stapler in sphincter-preserving operation for low rectal cancer

作　　者：熊晖 杨美方 郑勇斌[2] 马书进[2] 

机构地区：[1]湖北省监利县中医院普通外科,433300 [2]武汉大学人民医院胃肠外科

出　　处：《临床外科杂志》2007年第12期841-842,共2页Journal of Clinical Surgery

摘　　要：目的探索弧形切割缝合器在低位直肠癌(距肛缘4～7cm)保肛手术中的应用价值。方法47例低位直肠癌患者,按TME治疗原则行保肛手术,术中应用弧形切割缝合器行直肠-肛管间切割、闭合。术后随访6～18个月,回顾性分析其根治性、术后排便功能、手术并发症及局部复发率。结果本组无手术中死亡,术后病理学检查无切端癌残留,无大便失禁,吻合口漏2例,吻合口狭窄4例,局部复发1例,腹壁切口感染2例,盆腔感染1例,术后肿瘤局部复发1例。术后排便功能基本正常,控便能力满意。术后性功能3个月内基本恢复正常。排尿功能恢复时间7～20d(平均9d)。结论在低位直肠癌中应用弧形切割缝合器行保肛手术安全、有效,能获得较好的根治与保留肛门功能效应。Objective To evaluate the effect of total mesorectal excision with curved cutter stapler for low positioned rectal cancer （4-7 cm from anal verge） in the narrow pelvis. Methods Based on total mesorectal excision,47 cases of low positioned rectal cancer in the narrow pelvis underwent sphincter preserving operation with curved cutter stapler. The 6-18 months follow-up result was retro-spectively analyzed on radical resection effect, defecating function, complication rate and recurrent rate. Results All the resection margins were clear and the cases had no intraoperative death. Anastomotic leakage occurred in 4.3 % （2/47）, anastomotic stricture in 8.5 % （ 4/47 ）, local recurrent in 2, 1% （ 1 / 47）, and infection of incisional wound and cavitas pelvis in 4.3 % （2/47） and 2.1% （1/47 ）, respectively. The function of patient＇s sphincter anal was gradually recovered, and the function was basically come back after half year, and the defecation and sexual function recovered three months later. The micturition function was recovered after 7 to 20 days （average 9 days）. Conclusion Curability and anal function can be obtained by sphincter preserving operation. Curved cutter stapler is effective and safe for low positioned rectal cancers.

关 键 词：直肠肿瘤 外科缝合器 治疗 

分 类 号：R735.37[医药卫生—肿瘤]