早期低位直肠癌经腹肛门拖出切除双吻合器吻合的临床应用  

Pull-through transection and anastomosis for early lower rectal cancer using double stapling technique

作　　者：傅传刚[1] 王汉涛[1] 王颢[1] 

机构地区：[1]第二军医大学附属长海医院肛肠外科,上海200433

出　　处：《中华外科杂志》2008年第18期1378-1381,共4页Chinese Journal of Surgery

摘　　要：目的总结分析早期低位直肠癌经腹肛门拖出切除双吻合器吻合临床应用的经验体会。方法对2001年5月至2008年3月25例早期低位直肠癌采用经腹直肠游离，远端直肠腔内翻转经肛门拖出、直视下切除，双吻合器吻合。其中男性17例，女性8例，平均年龄45岁（26～57岁）。肿瘤下缘距齿线的平均距离为（3．2±0．5）cm（2．0—4．5cm），肿瘤平均最大直径为（2．8±0．8）cm（2．0—3．5cm）。结果肿瘤下缘距切缘的平均距离为（1．5±0．4）cm（1．1～2．2cm），切缘肿瘤均阴性。吻合口位于齿状线以上18例，距离0．3—2．1cm[（1．7±0．2）cm]，7例吻合口位于齿状线以下0．1—0．5cm（平均0．3cm）。一例术后吻合口漏，保守治疗愈合。术后随访6—62个月（平均32个月），局部复发1例（4．0％），远处肝脏转移3例（12．0％）；肺部转移2例（8．0％）。轻度大便失禁7例。结论对于早期低位早期直肠癌的切除，与经腹在盆腔内离断相比，将直肠经肛门翻出在直视下离断可以更准确地把握切断的位置，既保证安全的切除距离，又尽可能地多保留远端直肠，保留控便功能。Objective To introduce the experiences of pull-through transection and double stapling anastomosis for early lower rectal cancer. Methods From May 2001 to March 2008, 25 patients with early stage lower rectal cancer were operated by using pull-through transection and double stapling anastomosis. The average distance between the dentate line and lower margin of the tumor is （ 3.2 ± 0. 5 ） cm（ 2. 0-4. 5 cm）. The average tumor diameter is （2.8 ±0.8）cm（2.0-3.5 cm）. Results The average distance between the lower margin of the tumor and transection line is （ 1.5 ± 0. 4 ） cm （ 1.1-2. 2 cm ）. All the resection margins were negative. Eighteen cases of the anastomosis were above the dentate line, 0. 3-2. 1 cm [ （ 1.7 ± 0. 2 ）cm ] and the other 7 were below, 0. 1-0. 5 cm （ average 0. 3 cm ）. Anastomotie leakage occurred in 1 ease, and cured with conservative treatment. Local recurrence occurred in 1 case （ 4. 0% ）, liver metastasis in 3 （ 12. 0% ） and lung metastasis in 2 （ 8.0% ） , respectively. Mild fecal incontinence occurred in 7 eases. Conclusion Compared with trans-abdominal transection of distal rectum in low anterior resection of rectal cancer, pull-through transection and anastomosis provides more precise control of the cutting line and simpler resection.

关 键 词：直肠肿瘤 直肠肛门拖出 双吻合器吻合 

分 类 号：R686[医药卫生—骨科学]