直肠系膜全切除在双吻合器低位前切除术中的意义  

Total mesorectal excision in low anterior resection with double stapling technique

作　　者：郁宝铭[1] 李东华[1] 郑民华[1] 沈耀祥[1] 王灏[1] 

机构地区：[1]上海第二医科大学附属瑞金医院上海消化外科研究所,200025

出　　处：《中华外科杂志》2000年第7期496-498,共3页Chinese Journal of Surgery

摘　　要：目的　探讨直肠系膜全切除在双吻合器低位前切除术中的价值。　方法　对 1993年 1月～ 1998年 10月间 ,行直肠系膜全切除加双吻合器低位前切除术治疗的 30 6例直肠肿瘤患者的疗效、并发症等进行分析。　结果　本组无手术死亡病例 ,并发症中吻合口漏 9例 ,发生率为 2 9% ;输尿管损伤 2例 ,发生率 0 7% ;吻合口狭窄 32例 ,发生率为 10 5 %。术后复发 2 0例 ,复发率为 6 7% ,其中B期复发 4例 ,占B期 2 3% ;C期复发 9例 ,占 12 5 % ;D期复发 7例 ,占 5 3 9%。　结论　直肠系膜全切除可有效地降低吻合器低位前切除术后的局部复发率 ,并保证了低位和超低位前切除术的安全性。但患者局部复发率还与病期的早晚有关 ,因此 ,对本病的早期诊断和早期治疗也是降低术后局部复发率的重要环节。Abstract[WT5”BZ] To elucidate the value of total mesorectal excision (TME) in low anterior resection with double stapling technique. [WT5”HZ]Methods[WT5”BZ] During January 1993 to October 1998, 306 cases of rectal lesions were treated by total mesorectal excision in low anterior resection (LAR) with double stapling technique. Among the patients with rectal cancer, 235 (78 86%) were treated by low anterior resection and 97 (41 28%) by ultra low anterior resection. [WT5”HZ]Results[WT5”BZ] No operative death was noted, and anastomotic leakage occurred in 9(2 94%) patients. Ureter injury occurred in 2(0 65%) patients . 32(10 46%) patients suffered from anastomotic stenosis, 31 mm diameter of stapler for 27 (12 68%) patients and 33 mm diameter of stapler for 5 patients (5 38%). Local recurrence occurred in 20 (6 71%) patients: Dukes′ B 4 (2 33%) patients, Dukes′C 9 (12 5%) patients, and Dukes′D 7 (53 85%) pateints. [WT5”HZ]Conclusions[WT5”BZ] Total mesorectal excision can effectively reduce the local recurrence rate after LAR with double stapling technique. Since the recurrence is closely related to the stage of the disease, early detection, early diagnosis and early treatment are extremely important. [WT5”HZ]

关 键 词：直肠肿瘤 直肠系膜全切除 双吻合器低位前切除 

分 类 号：R657.2[医药卫生—外科学]