锐达智能弧形切割吻合器在腹腔镜低位直肠癌保肛手术中的应用  

Application of Endo GIA^(TM) Radia Reload intelligent curved cutter stapler on laparoscopic with the anus preserving operationin low rectal cancer

作　　者：侯贤琼[1] 廖康雄[1] 魏文波[1] 谢容明[1] 陈秋文[1] 

机构地区：[1]揭阳市人民医院胃肠外科,广东揭阳522091

出　　处：《岭南现代临床外科》2016年第2期160-163,共4页Lingnan Modern Clinics in Surgery

摘　　要：目的探讨锐达智能弧形切割吻合器在腹腔镜低位直肠癌保肛手术中的应用效果与体会。方法 2014年3月至2015年6月选择50例低位直肠癌患者在腹腔镜下全直肠系膜切除基础上,应用锐达智能弧形切割吻合器对直肠残端进行切割闭合,用迈思强CCS 29 mm管状吻合器进行低位或超低位结肠-直肠(肛管)吻合术。观察治疗后根治性、手术并发症、术后排便功能与局部复发情况。结果全组50例均在腹腔镜下完成手术,吻合成功率100%,手术时间173±18 min,其中放置钉仓时间18±4 min,肿瘤大小6.3±1.5 cm,肿瘤距齿状线5.5±0.7 cm,住院费用47796±2138元。其中13例超低位直肠癌行预防性回肠造瘘,所有病例术后均无吻合口瘘、吻合口狭窄、吻合口出血,亦无排尿障碍、切口感染等并发症,无手术死亡病例。随访6~21个月,随访期内均未发现复发病例。术后50%病例有不同程度的排便功能障碍,3~6个月后逐渐恢复正常。结论应用锐达智能弧形切割吻合器对腹腔镜低位直肠癌保肛手术是安全有效的,放置锐达需要一定的技巧。Objective To explore Endo GIA^（TM）radial reload intelligent curved cutter stapleron laparoscopic retention anus operation in patients with low rectal cancer. Methods Fifty cases of rectal cancer patients were included in the study and underwent laparoscopic total mesorectal resection byusing radial reloads intelligent arc cutter stapler of the rectal stump cutting closure. [CCS 29 mm circular staplar,Johnson Johnson Medical（China Ltd.） ] from March 2014 to June 2015. Operative complication, defecation function and local recurrence were observedand recorded. Results All 50 patients finished surgery smoothly. The tumor size was 6.3±1.5 cm. The operation time was 173 ±18min, including placed screw 18 ±4 min.The tumor size 6.3 ±1.5 cm,and the tumor from the dentate line was 5.5±0.7 cm. The hospitalization expenses was 47 796±2138 yuan. Of 50 cases,13 cases of ultra-low rectal cancer underwent preventive ileum fistulation. All cases had no anastomotic leakage,anastomotic stenosis, anastomotic bleeding, voiding dysfunction,.infection of incisional wound..The patients were followed up for 6-21 months. There were no anastomotic bleeding and anastomotic leakage..There were no local recurrence and distant metastasis during a median follow-up postoperatively..Conclusion...Application of Endo GIA^（TM）radial reload intelligent arc cutting stapler for low rectal cancer by laparoscopic sphincter preserving surgery is safe and effective, and placing the radial reloads has certain skills.

关 键 词：直肠癌 锐达 弧形切割吻合器 全直肠系膜切除 保肛手术 

分 类 号：R657.1[医药卫生—外科学] R735.37[医药卫生—临床医学]