弧形切割闭合器在低位直肠癌保肛术中的应用
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余枭 E-mail:yuxiaoyx4@126.com

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Use of curved cutter stapler in sphincter-preserving surgery for low rectal cancer 
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    摘要:

    目的:探讨弧形切割闭合器在低位直肠癌超低位前切除术中的应用价值。
    方法:对2006年1月—2010年12月由同一组主刀医师完成63例低位直肠癌根治性切除的患者进行前瞻性研究。患者在全直肠系膜切除和侧方淋巴结清扫的基础上,随机分组分别应用弧形切割吻合器(观察组)与直线型闭合器(对照组)对直肠(肛管)残端进行切割、闭合,用32 mm弯形管型吻合器进行超低位结肠―直肠(肛管)吻合术,比较两组的优缺点。
    结果:术中采用弧形切割闭合器的32例低位直肠癌患者无切割和闭合不全者,术后无1例发生吻合口瘘;手术时间明显缩短[(117.3±37.5)min vs. (149.3±42.4) min,P<0.05)],术后并发症发生率明显低于对照组(9.4% vs. 19.4%,P<0.05),保肛成功率亦高于对照组[100%(32/32)vs. 90.3%(28/31),P<0.05]。
    结论:弧形切割闭合器在低位直肠癌超低位前切除术中具有切割完整、闭合确实、手术时间短、相关并发症发生率低、中转Miles术少的优点,具有良好的应用推广前景。

    Abstract:

    Objective:To evaluate the applicability of curved cutter stapler in the ultra-low anterior resection with sphincter-preserving surgery for low rectal cancer.
    Methods:A prospective study was carried out on 63 patients with low rectal cancer who underwent radical resection by the same surgical team from January 2006 to December 2010. Following total mesorectal excision (TME) and lateral lymph node dissection (LLND), the patients were randomly assigned either to use curved cutter stapler (the ContourTM, observation group) or to use linear cutter stapler (control group) during the distal rectum (anus) transection and closure. Finally, the ultra-low colo-rectal (anal) anastomosis was performed by a 32 mm curved intraluminal stapler. The advantages and disadvantages of the two methods were compared.
    Results:The rectal (anal) remnant and colorectal (anal) closure were conducted perfectly in the 32 cases with curved cutter stapler during operation. No postoperative anastomotic fistula occurred. Compared with the control group, the operation time was shorter [(117.3±37.5)min vs. (149.3±42.4)min, P<0.05)] and complication rate was lower in the observation group (9.4% vs. 19.4%, P<0.05). The rate of sphincter-preservation in the observation group was also higher than that of the control group [100% (32/32) vs. 90.3% (28/31), P<0.05]. 
    Conclusions:Curved cutter stapler has the advantage of complete cutting and closure, shorter operation time, low related complication incidence and low convertion to Miles method in the ultra-low anterior resection for low rectal cancer. It has great application prospects.

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贺舜民| 余枭| 汪东文| 宋军| 杨永超| 唐华勇.弧形切割闭合器在低位直肠癌保肛术中的应用[J].中国普通外科杂志,2011,20(7):756-759.
DOI:10.7659/j. issn.1005-6947.2011.07.024

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  • 收稿日期:2011-04-19
  • 最后修改日期:2011-07-05
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  • 在线发布日期: 2011-07-15