应用镍钛记忆合金加压吻合环进行肠道吻合的前瞻性研究  

Colorectal anastomosis using nickel titanium compression anastomosis ring： a prospective study

作　　者：李良庆[1] 沈俊涛[1] 王家兴[1] 

机构地区：[1]福建医科大学附属第一医院胃肠外科,福州350005

出　　处：《中华消化外科杂志》2012年第2期173-176,共4页Chinese Journal of Digestive Surgery

摘　　要：目的探讨应用一种新型镍钛记忆合金加压吻合环（CAR）进行结直肠癌手术肠道吻合的可行性和安全性。方法前瞻性随机对照分析2010年5月至12月福建医科大学附属第一医院收治的83例行肠道吻合的结直肠癌患者的临床资料。将患者按随机数字表法分成CAR组（41例）和金属钉吻合器组（42例），分别采用CAR或金属钉吻合器行肠道吻合，观察两组患者手术时间、术后肛门排气及排便时间、住院时间、术后愈合情况、术后有无与吻合相关的并发症发生，CAR组患者吻合环的排出时间等。计量资料采用t检验，计数资料采用x2检验。结果CAR组和金属钉吻合器组患者的平均手术时间分别为（122±25）min和（128±30）min；吻合口瘘发生率分别为5％（2／41）和7％（3／42），吻合口瘘患者经行手术或保守治疗痊愈；两组患者平均手术时间，术后肛门排气、排便时间，住院时间及吻合口瘘发生率比较，差异均无统计学意义（t=1．299，0．756，1．636，0．974，0=0．165，P〉0．05）。CAR组患者于术后9—14d随粪便排出吻合环，术后未发生吻合口狭窄；金属钉吻合器组患者吻合口狭窄发生率为2％（1／42），两组比较，差异无统计学意义（X2=0．988，P〉0．05）。CAR组患者术后吻合口平滑、完整、愈合良好；金属钉吻合器组患者可见吻合钉残留在吻合口，并有1例形成炎性息肉。结论使用CAR行结直肠癌手术肠道吻合是一种简便且安全有效的方法。Objective To investigate the feasibility and safety of colorectal anastomosis using nickel titanium compression anastomosis ring （CAR）. Methods The clinical data of 83 patients who received colorectal anastomosis at the First Affiliated Hospital of Fujian Medical University from May to December, 2010 were prospectively analyzed. All patients were divided into CAR group （41 patients） and stapler group （42 patients） according to the random number table. The operation time, time to postoperative flatus and bowel movement, duration of hospital stay and the incidence of anastomosis-related complications of the 2 groups were observed. The time of extrusion of the tings and anastomotic healing of the CAR group were recorded. All data were analyzed by the t test or chi-square test. Results The mean operation time of the CAR group and the stapler group were （ 122±25 ） minutes and （ 128±30） minutes, respectively. The incidences of postoperative anastomotic fistula of the CAR group and the stapler group were 5% （2/41） and 7% （3/42）, and the anastomotic fistula was cured by operation or conservative treatment. There were no significant differences in the mean operation time, time to postoperative flatus and bowel movement, duration of hospital stay and incidence of anastomotic fistula between the 2 groups （t =1.299, 0.756, 1.636, 0.974, Xz =0. 165, P 〉0.05）. The rings were expelled within 9-14 days. The incidences of anastomotic stenosis of the CAR group and stapler group were 0（0/41 ） and 2% （1/42） , with no significant difference between the 2 groups （ X2= 0. 988, P 〉 0.05 ）. The anastomotic stoma was smooth and well healed in the CAR group, while nail residues and inflammatory polyp （1 patient） were found at the anastomosis stoma in the stapler group. Conclusion Nickel titanium CAR is safe and effective in colorectal anastomosis.

关 键 词：结直肠肿瘤 镍钛记忆合金加压吻合环 金属钉吻合器 

分 类 号：R735.3[医药卫生—肿瘤]