经肛门拖出式切除、双吻合器技术在家族性腺瘤性息肉病手术中的应用  

The application of pull-out resection through anal canal with double stapling technique in the oper- ation for familial adenomatous polyposis

作　　者：吴刚[1] 沈新明[1] 钱群[2] 江从庆[2] 

机构地区：[1]武汉科技大学附属天佑医院普外科, 430064 [2]武汉大学中南医院结直肠肛门外科、结直肠肛门疾病研究中心、湖北省肠病医学临床研究中心

出　　处：《临床外科杂志》2013年第3期186-187,共2页Journal of Clinical Surgery

摘　　要：目的探讨经肛门拖出式切除、双吻合器技术在全结直肠切除、回肠“J”pouch肛管吻合术治疗家族性腺瘤性息肉病中的应用价值。方法对24例家族性腺瘤性息肉病患者在充分游离结肠、分离直肠后，经肛门拖出直肠，在肛门外齿状线上方1．0cm处用闭合器离断直肠，圆型吻合器行回肠“J”pouch肛管吻合。结果术后发生吻合口漏、吻合口出血、切口感染、粘连性小肠梗阻各1例，贮袋炎3例。18例患者随访3年以上，平均大便次数为4．0次／天。结论对家族性腺瘤性息肉病患者，经肛门拖出式切除并结合双吻合器技术行超低位直肠癌保肛术是切实可行、安全可靠的治疗方法。Objective To discuss the application of pull-out resection through anal canal with double stapling technique in the proctocolectomy and J-pouch ileo-anal anastomosis for familial adenoma- tous polyposis （FAP）. Methods The clinical data of 24 FAP patients who underwent the proctocolectomy and J-pouch ileo-anal anastomosis were collected and analyzed retrospectively. After separation of colon and rectum, the distal rectum was pulled out through anal canal. The distal rectum was sutured, dissected, and closed at the 0.5 cm to 1 cm level away from the dentate line. Anastomosis between ileal J-pouch and anal canal was performed using a tubular stapler. Results There were 7 cases of postoperative complica- tions including 1 anastomotic fistula, 1 anastomotic bleeding, 1 incisional infection, 1 small bowel obstruc- tion,and 3 pouchitis. During the 3-year follow-up of 18 patients,the average frequency of defecation was 4 times per day. Conclusion The method of pull-out resection through anal canal with double stapling tech- nique is safe and effective in the proctocolectomy and J-pouch ileo-anal anastomosis for FAP.

关 键 词：拖出式切除 双吻合器 家族性腺瘤性息肉病 全结直肠切除 

分 类 号：R656.7[医药卫生—外科学]