超低位直腸癌保肛術中使用小口徑吻合器的臨床研究_《中國普外基礎與臨床雜志》

作者：

李智 , 袁龍 , 徐本玲 , 萬相斌 , 韓廣森

河南省腫瘤醫院普外科（鄭州 450003）;

關鍵詞：

直腸腫瘤吻合器肛門外科手術

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的探討超低位直腸癌前切除術中應用小口徑吻合器的安全性及優勢。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。分別使用33 mm口徑吻合器和29 mm口徑吻合器進行吻合,每組各30例，對比分析2組患者術中、術后及預后情況。結果 33 mm口徑吻合器組術中單純吻合時間為（9.0±3.3） min，29 mm口徑吻合器組為（6.0±2.6） min，2組比較差異有統計學意義(P=0.022 5)；術中因損傷致吻合不良而需行吻合口修補者33 mm口徑吻合器組6例，29 mm口徑吻合器組2例，2組比較差異有統計學意義(P=0.030 1)； 2組的總手術時間，術后吻合口漏、狹窄、出血、復發、大便失禁的發生情況及住院時間差異均無統計學意義(P gt;0.05)。結論在超低位直腸癌前切除術中，使用29 mm口徑吻合器可以降低手術難度，縮短術中吻合口的吻合時間，但不增加術后吻合口狹窄及其他并發癥的發生。

引用本文： 李智,袁龍,徐本玲,萬相斌,韓廣森. 超低位直腸癌保肛術中使用小口徑吻合器的臨床研究. 中國普外基礎與臨床雜志, 2010, 17(11): 1175-1178. doi: 復制

1.	郁寶銘. 結直腸癌外科治療的現狀和展望 [J]. 中國普外基礎與臨床雜志, 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.	Mkel 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. 不同時期低位直腸癌根治手術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防與處理 [J]. 中國實用外科雜志, 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 并雙吻合器吻合術后吻合口效果觀察 [J]. 中國普外基礎與臨床雜志, 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. 結直腸癌外科治療的現狀和展望 [J]. 中國普外基礎與臨床雜志, 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. Mkel 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. 不同時期低位直腸癌根治手術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防與處理 [J]. 中國實用外科雜志, 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 并雙吻合器吻合術后吻合口效果觀察 [J]. 中國普外基礎與臨床雜志, 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.

《中國普外基礎與臨床雜志》

超低位直腸癌保肛術中使用小口徑吻合器的臨床研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

《中國普外基礎與臨床雜志》

超低位直腸癌保肛術中使用小口徑吻合器的臨床研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料