低位/超低位直肠癌结肛吻合术中运用单吻合器及双吻合器技术的疗效比较  

Comparison of The Application of Double Stapling Technique and Single Stapling Technique in The Low or Ultralow Anterior Rectal Resection and Colon-Anal Canal Anastomosis for Patients with Rectal Cancer

作　　者：管秀雯[1,2] 李山晨[1,2] 汪晓东[1,2] 李立[1,2] 

机构地区：[1]四川大学华西医院胃肠外科中心,四川成都610041 [2]四川大学华西临床医学院/华西医院MCQ团队,四川成都610041

出　　处：《中国普外基础与临床杂志》2013年第3期287-292,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川大学科学探索计划资助项目(项目编号:2011050495)~~

摘　　要：目的比较在低位/超低位直肠癌结肛吻合术中运用单吻合器技术(SST)和双吻合器技术(DST)进行吻合重建的效果。方法回顾性分析2009年1月至2010年12月期间四川大学华西医院胃肠外科中心结直肠外科专业组收治的351例低位/超低位直肠癌患者的临床资料,比较采用SST(n=49)和DST(n=302)进行结肛吻合患者的术中和术后情况。结果与DST组比较,SST组患者的肿瘤下缘距齿状线距离较短(P<0.05),远端切缘长度较短〔(1.83±0.59)cm比(2.07±0.56)cm,P<0.05〕,手术时间较长〔(112.86±39.29)min比(100.10±36.75)min,P<0.05〕,住院费用较低〔(24 350.48±7 812.73)元比(29 455.32±7 869.33)元,P<0.05〕。而2组患者的术中出血量,首次下床活动时间,首次排气、排便时间,拔除胃管、尿管及引流管时间,术后住院时间、总住院时间及术后并发症发生率比较差异均无统计学意义(P>0.05)。术后所有患者的肛门控便功能均恢复良好。术后全部获访,随访时间6～24个月,平均16个月。随访期间,局部复发1例(SST组);远处转移3例(均为DST组);死亡15例(4.27%),其中DST组13例(4.30%),SST组2例(4.08%)。结论低位/超低位直肠癌结肛吻合术中SST的远端切缘长度较DST短,适用于肿瘤位置较低的患者,并且其住院费用也较DST低。Objective To compare the effects of double stapling technique（DST） and single stapling technique（SST） in the low or ultralow anterior rectal resection and colon-anal canal anastomosis for patients with rectal cancer.Methods The clinical data of 351 patients with rectal caner,who were treated with low or ultralow anterior resection and colon-anal canal anastomosis in West China Hospital from Jan.2009 to Dec.2010,were collected and analyzed retrospectively.Operative and postoperative indexes of patients treated with DST（n=302） and SST（n=49） were compared.Results Compared with DST group,the distance from the dentate line to the edge of tumor,the length of the distal surgical margin（（1.83±0.59） cm vs.（2.07±0.56） cm）？,and hospitalization cost（（24 350.48±7 812.73） yuan vs.（29 455.32±7 869.33） yuan） of SST group were shorter or lower（P0.05）,but operative time was longer（（112.86±39.29） min vs.（100.10±36.75） min,P0.05）.There were no significant differences on blood loss,duration of firstambulation,duration of first passing flatus,duration of first bowel movement,duration of pulling out nasogastric tube,duration of pulling out urinary catheter,duration of pulling out drain,postoperative hospital stay,total length of hospital stay,and the incidence of complication between the 2 groups（P0.05）.All patients were in functional recovery of anal control after operation.All patients were followed-up for 6-24 months（average 16 months）.During the followed-up,only 1 case suffered local tumor recurrence（SST group）,3 cases suffered distant metastases（all in DST group）,and 15 cases（4.27%） died,of which 13 cases（4.30%） in DST group and 2 cases（4.08%） in SST group.Conclusions As in the low or ultralow anterior rectal resection and colon-anal canal anastomosis for patients with rectal cancer,SST results in shorter distal surgical margin than DST,so SST is suitable for the patients with shorter distance from the dentate line to the edge of tumor.What

关 键 词：吻合器 直肠癌 结肛吻合术 低位前切除 

分 类 号：R735.37[医药卫生—肿瘤]