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目的比较在低位/超低位直肠癌结肛吻合术中运用单吻合器技术(SST)和双吻合器技术(DST)进行吻合重建的效果。方法回顾性分析2009年1月至2010年12月期间四川大学华西医院胃肠外科中心结直肠外科专业组收治的351例低位/超低位直肠癌患者的临床资料,比较采用SST(n=49)和DST(n=302)进行结肛吻合患者的术中和术后情况。结果与DST组比较,SST组患者的肿瘤下缘距齿状线距离较短(P<0.05),远端切缘长度较短〔(1.83±0.59)cm比(2.07±0.56)cm,P<0.05〕,手术时间较长〔(112.86±39.29)min比(100.10±36.75)min,P<0.05〕,住院费用较低〔(24 350.48±7 812.73)元比(29 455.32±7 869.33)元,P<0.05〕。而2组患者的术中出血量,首次下床活动时间,首次排气、排便时间,拔除胃管、尿管及引流管时间,术后住院时间、总住院时间及术后并发症发生率比较差异均无统计学意义(P>0.05)。术后所有患者的肛门控便功能均恢复良好。术后全部获访,随访时间6～24个月,平均16个月。随访期间,局部复发1例(SST组);远处转移3例(均为DST组);死亡15例(4.27%),其中DST组13例(4.30%),SST组2例(4.08%)。结论低位/超低位直肠癌结肛吻合术中SST的远端切缘长度较DST短,适用于肿瘤位置较低的患者,并且其住院费用也较DST低。
Objective To compare the effect of anastomosis reconstructed with single stapling technique (SST) and double stapling technique (DST) in low / ultra low rectal cancer anastomosis. Methods The clinical data of 351 patients with low / low rectal cancer admitted to the Department of Colorectal Surgery, West China Hospital of Sichuan University from January 2009 to December 2010 were retrospectively analyzed. SST (n = 49) And DST (n = 302) performed anastomosis in patients with intraoperative and postoperative conditions. Results Compared with DST group, the lower edge of the tumor in the SST group was shorter (P <0.05) and the length of the distal edge was shorter (1.83 ± 0.59) cm (2.07 ± 0.56) cm, P < 0.05). The operation time was longer (112.86 ± 39.29 min vs 100.10 ± 36.75 min, P <0.05), and the hospitalization cost was lower (24 350.48 ± 7.812.73 yuan vs 29 455.32 ± 7 869.33 yuan) P <0.05]. The two groups of patients with intraoperative blood loss, time to first bed activity, the first exhaust, defecation time, gastric tube removal, catheter and drainage tube time, postoperative hospital stay, total hospital stay and postoperative complications compared There was no significant difference (P> 0.05). Postoperative anal control in all patients were restored to good function. All patients were followed up for 6-24 months with an average of 16 months. During the follow-up period, there were 1 case of local recurrence (SST group), 3 cases of distant metastasis (all were DST group) and 15 cases died of death (4.27%), of which 13 cases (4.30%) in DST group and 2 cases (4.08% . Conclusion The distal margin of SST in the low / super low rectal cancer anastomosis and anastomosis surgery is shorter than DST, which is suitable for patients with lower tumor location and lower hospitalization costs than DST.