目的 探討超低位直腸癌前切除術(shù)中應(yīng)用小口徑吻合器的安全性及優(yōu)勢(shì)。方法 回顧性分析2006年 6月至 2009年 6月期間我院普外科收治的60例超低位直腸癌患者的臨床資料，均按TME原則行直腸癌雙吻合器法前切除術(shù)。分別使用33 mm口徑吻合器和29 mm口徑吻合器進(jìn)行吻合,每組各30例，對(duì)比分析2組患者術(shù)中、術(shù)后及預(yù)后情況。結(jié)果 33 mm口徑吻合器組術(shù)中單純吻合時(shí)間為（9.0±3.3） min，29 mm口徑吻合器組為（6.0±2.6） min，2組比較差異有統(tǒng)計(jì)學(xué)意義(P=0.022 5)； 術(shù)中因損傷致吻合不良而需行吻合口修補(bǔ)者33 mm口徑吻合器組6例，29 mm口徑吻合器組2例，2組比較差異有統(tǒng)計(jì)學(xué)意義(P=0.030 1)； 2組的總手術(shù)時(shí)間，術(shù)后吻合口漏、狹窄、出血、復(fù)發(fā)、大便失禁的發(fā)生情況及住院時(shí)間差異均無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05)。結(jié)論 在超低位直腸癌前切除術(shù)中，使用29 mm口徑吻合器可以降低手術(shù)難度，縮短術(shù)中吻合口的吻合時(shí)間，但不增加術(shù)后吻合口狹窄及其他并發(fā)癥的發(fā)生。
引用本文： 李智,袁龍,徐本玲,萬(wàn)相斌,韓廣森. 超低位直腸癌保肛術(shù)中使用小口徑吻合器的臨床研究. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(11): 1175-1178. doi: 復(fù)制
| 1. | 郁寶銘. 結(jié)直腸癌外科治療的現(xiàn)狀和展望 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(9): 631-636. |
| 2. | Heald RJ, Karanjia ND. Results of radical surgery for rectal cancer [J]. World J Surg, 1992； 16(5): 848-857. |
| 3. | Andreola S, Leo E, Belli F, et al. Adenocarcimoma of the lower third of the rectum surgically treated with a<10-MM distal clearance: preliminary results in 35 NO patients [J]. Surg Oncol, 2001； 8(7): 611-615. |
| 4. | Kapipeijn E, van De Velde CJ. European trials with total mesorectal excision [J]. Semin Surg Oncol, 2000； 19(4): 350-357. |
| 5. | Killingback M, Barron P, Dent OF. Local recurrence after curative resection of cancer of the rectum without total mesorectal excision [J]. Dis Colon Rectum, 2001； 44(4): 473-483; discussion 483-486. |
| 6. | Griffen FD, Knight CD Sr, Whitaker JM, et al. The double stapling technique for low anterior resection. Results, modifications, and observation [J]. Ann Surg， 1990； 211(6): 745-751; discussion 751-752. |
| 7. | Nesbakken A, Nygaard K, Lunde OC. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer [J]. Br J Surg, 2001； 88(3): 400-404. |
| 8. | Sato H, Maeda K, Hanai T, et al. Modified double-stapling technique in low anterior resection for lower rectal carcinom [J]. Surg Today, 2006; 36(1)： 30-36. |
| 9. | Asao T, Kuwano H, Nakamura J, et al. Use of a mattress suture to eliminate dog ears in double-stapled and triple-stapled anastomoses [J]. Dis Colon Rectum, 2002; 45(1)： 137-139. |
| 10. | Roumen RM, Rahusen FT, Wijnen MH, et al. “Dog ear” for mation after double-stapled low anterior resection as a risk factor for anastomotic disruption [J]. Dis Colon Rectum, 2000; 43(4)： 522-525. |
| 11. | Mkel JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis [J]. Dis Colon Rectum, 2003； 46(5)： 653-660. |
| 12. | Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence？ [J]. Br J Surg, 1982； 69(10)： 613-616. |
| 13. | Peeters KC， Tollenaar RA， Marijnen CA， et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer [J]. Br J Surg, 2005； 92(2): 211-216. |
| 14. | Detry RJ, Kartheuser A, Delriviere L, et al. Use of the circular stapler in 1000 consecutive colorectal anastomoses: experience of one surgical team [J]. Surgery, 1995； 117(2): 140-145. |
| 15. | 汪建平, 吳小劍, 宋新明, 等. 不同時(shí)期低位直腸癌根治手術(shù)保肛率的變化及其因素分析 [J]. 中華胃腸外科雜志, 2006； 9(2): 107-110. |
| 16. | 李東華, 郁寶銘, 鄭民華, 等. 低位前切除術(shù)后吻合口瘺的探討 [J]. 中華胃腸外科雜志, 2000； 3(4): 243-244. |
| 17. | 劉萌華. 低位直腸癌吻合口瘺和直腸陰道瘺的預(yù)防與處理 [J]. 中國(guó)實(shí)用外科雜志, 2007； 27(6): 448-450. |
| 18. | Agaba EA. Does rectal washout during anterior resection prevent local tumor recurrence? [J]. Dis Colon Rectum, 2004； 47(3): 291-296. |
| 19. | Tjandra JJ, Kilkenny JW, Buie WD, et al. Practice parameters for the management of rectal cancer (revised) [J]. Dis Colon Rectum， 2005； 48(3): 411-423. |
| 20. | Terzi C, Unek T, Saˇgol O, et al. Is rectal washout necessary in anterior resection for rectal cancer? A prospective clinical study [J]. World J Surg, 2006； 30(2): 233-241. |
| 21. | Maeda K, Maruta M, Hanai T, et al. Irrigation volume determines the efficacy of “rectal washout” [J]. Dis Colon Rectum, 2004； 47(10): 1706-1710. |
| 22. | Fukunaga Y, Higashino M, Tanimura S, et al. New technique for rectal division in laparoscopic anterior resection--with video [J]. World J Surg, 2008； 32(9): 2095-2100. |
| 23. | 鄭斌. 中低位直腸癌 TME 并雙吻合器吻合術(shù)后吻合口效果觀察 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009； 16(6): 481-482. |
| 24. | Hida J, Yoshifuji T, Tokoro T, et al. Comparison of long-term functional results of colonic J-pouch and straight anastomosis after low anterior resection for rectal cancer: a five-year follow-up [J]. Dis Colon Rectum, 2004； 47(10): 1578-1585. |
| 25. | Bretagnol F, Troubat H, Laurent C, et al. Long-term functional results after sphincter-saving resection for rectal cancer [J]. Gastroenterol Clin Biol, 2004； 28(2): 155-159. |
- 1. 郁寶銘. 結(jié)直腸癌外科治療的現(xiàn)狀和展望 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(9): 631-636.
- 2. Heald RJ, Karanjia ND. Results of radical surgery for rectal cancer [J]. World J Surg, 1992； 16(5): 848-857.
- 3. Andreola S, Leo E, Belli F, et al. Adenocarcimoma of the lower third of the rectum surgically treated with a<10-MM distal clearance: preliminary results in 35 NO patients [J]. Surg Oncol, 2001； 8(7): 611-615.
- 4. Kapipeijn E, van De Velde CJ. European trials with total mesorectal excision [J]. Semin Surg Oncol, 2000； 19(4): 350-357.
- 5. Killingback M, Barron P, Dent OF. Local recurrence after curative resection of cancer of the rectum without total mesorectal excision [J]. Dis Colon Rectum, 2001； 44(4): 473-483; discussion 483-486.
- 6. Griffen FD, Knight CD Sr, Whitaker JM, et al. The double stapling technique for low anterior resection. Results, modifications, and observation [J]. Ann Surg， 1990； 211(6): 745-751; discussion 751-752.
- 7. Nesbakken A, Nygaard K, Lunde OC. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer [J]. Br J Surg, 2001； 88(3): 400-404.
- 8. Sato H, Maeda K, Hanai T, et al. Modified double-stapling technique in low anterior resection for lower rectal carcinom [J]. Surg Today, 2006; 36(1)： 30-36.
- 9. Asao T, Kuwano H, Nakamura J, et al. Use of a mattress suture to eliminate dog ears in double-stapled and triple-stapled anastomoses [J]. Dis Colon Rectum, 2002; 45(1)： 137-139.
- 10. Roumen RM, Rahusen FT, Wijnen MH, et al. “Dog ear” for mation after double-stapled low anterior resection as a risk factor for anastomotic disruption [J]. Dis Colon Rectum, 2000; 43(4)： 522-525.
- 11. Mkel JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis [J]. Dis Colon Rectum, 2003； 46(5)： 653-660.
- 12. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence？ [J]. Br J Surg, 1982； 69(10)： 613-616.
- 13. Peeters KC， Tollenaar RA， Marijnen CA， et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer [J]. Br J Surg, 2005； 92(2): 211-216.
- 14. Detry RJ, Kartheuser A, Delriviere L, et al. Use of the circular stapler in 1000 consecutive colorectal anastomoses: experience of one surgical team [J]. Surgery, 1995； 117(2): 140-145.
- 15. 汪建平, 吳小劍, 宋新明, 等. 不同時(shí)期低位直腸癌根治手術(shù)保肛率的變化及其因素分析 [J]. 中華胃腸外科雜志, 2006； 9(2): 107-110.
- 16. 李東華, 郁寶銘, 鄭民華, 等. 低位前切除術(shù)后吻合口瘺的探討 [J]. 中華胃腸外科雜志, 2000； 3(4): 243-244.
- 17. 劉萌華. 低位直腸癌吻合口瘺和直腸陰道瘺的預(yù)防與處理 [J]. 中國(guó)實(shí)用外科雜志, 2007； 27(6): 448-450.
- 18. Agaba EA. Does rectal washout during anterior resection prevent local tumor recurrence? [J]. Dis Colon Rectum, 2004； 47(3): 291-296.
- 19. Tjandra JJ, Kilkenny JW, Buie WD, et al. Practice parameters for the management of rectal cancer (revised) [J]. Dis Colon Rectum， 2005； 48(3): 411-423.
- 20. Terzi C, Unek T, Saˇgol O, et al. Is rectal washout necessary in anterior resection for rectal cancer? A prospective clinical study [J]. World J Surg, 2006； 30(2): 233-241.
- 21. Maeda K, Maruta M, Hanai T, et al. Irrigation volume determines the efficacy of “rectal washout” [J]. Dis Colon Rectum, 2004； 47(10): 1706-1710.
- 22. Fukunaga Y, Higashino M, Tanimura S, et al. New technique for rectal division in laparoscopic anterior resection--with video [J]. World J Surg, 2008； 32(9): 2095-2100.
- 23. 鄭斌. 中低位直腸癌 TME 并雙吻合器吻合術(shù)后吻合口效果觀察 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009； 16(6): 481-482.
- 24. Hida J, Yoshifuji T, Tokoro T, et al. Comparison of long-term functional results of colonic J-pouch and straight anastomosis after low anterior resection for rectal cancer: a five-year follow-up [J]. Dis Colon Rectum, 2004； 47(10): 1578-1585.
- 25. Bretagnol F, Troubat H, Laurent C, et al. Long-term functional results after sphincter-saving resection for rectal cancer [J]. Gastroenterol Clin Biol, 2004； 28(2): 155-159.