经肛门拖出切除联合双吻合器技术在低位直肠癌保肛术中的临床研究  

Clinical Study of Transanal Pull-through Combined with Double Stapling Technique for Anus Conservation in Surgical Resection of Low Rectal Cancer

作　　者：陈斌[1] 林奎生[1] 陈进渠[1] 蒲斌[1] 

机构地区：[1]厦门市第三医院胃肠外科,361100

出　　处：《实用癌症杂志》2011年第3期297-299,共3页The Practical Journal of Cancer

摘　　要：目的探讨经肛门拖出切除联合双吻合器技术在低位直肠癌保肛手术中的应用价值。方法对29例低位直肠癌,采用充分分离直肠并离断肿瘤近端后经肛门拖出,直线型吻合器切闭肿瘤远端,圆形吻合器行端端吻合。肿瘤下缘距齿状线的平均距离为（3.0±0.5）cm（2.5~4.0 cm）。Dukes A期8例,B期17例,C期4例。结果所有患者保肛手术成功,无手术死亡。术后病理检查残端无肿瘤残留,发生吻合口漏1例（3.4%）,吻合口狭窄3例（10.3%）。随访6~60个月（平均30个月）,盆腔复发1例（3.4%）,吻合口复发1例（3.4%）,肝转移4例（13.8%）,肺转移3例（10.3%）。结论经肛门拖出切除联合双吻合器保肛术治疗低位直肠癌保肛成功率高,复发率低,安全可靠。Objective To discuss the value of transanal pull-through combined with double stapling technique for anus conservation in surgical resection of low rectal cancer.Methods 29 patients with low rectal cancer were operated,the rectum was thoroughly separated,cut off at the proximal end and pull out through anal canal,linear type closer was applied to close the distant end to the tumor,then end to end anastomosis was made with circular stapler.The average distance between the dentate line and lower margin of the tumor is（3.0±0.5）cm（2.5~4.0）cm.The cases included 8 patients in Dukes A stage,17 Dukes B and 4 Dukes C.Results The anus of all patients was successfully conserved with no deat）h occurred during operation.Pathological examination after operation showed no residual carcinoma in stumps.Only 1 case（3.4%） got anastomotic leakage,and 3 cases had anastomotic narrowing.The patients were followed up for 6~60 months（mean 30 months）.Recurrence in pelvic cavity occurred in 1,nanstomotic recurrence in 1 and liver metastasis in 4 and lung mestastasis in 3.Conclusion Transanal pull-through combined with double stapling technique is safe and effective with a highly sussccessful rate and a low recurrence rate for anus conservation in surgical resection of low rectal cancer.

关 键 词：经肛门拖出 双吻合器 低位直肠癌 保肛 

分 类 号：R735.37[医药卫生—肿瘤]