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目的探讨在超低位直肠癌保肛手术中联合使用多把吻合器进行保肛手术的安全性及可靠性。方法选择我院直肠癌患者共40例,按随机数字法分为实验组和对照组,两组组间性别、年龄、病情及伴随疾病等情况无明显差异,对照组行传统术式(经腹会阴联合直肠癌根治术miles);实验组中11例采用了二吻合器法实施了保肛手术,9例采用了三吻合器法实施了保肛手术,所有手术病人保证其手术切缘阴性。随访观察两组患者术后恢复时间、住院时间、术后并发症出现情况、术后生活质量满意度等指标,同时记录患者生存期。结果两组患者在性别、年龄、并发症及病理分期上差异无统计学意义。实验组患者手术时间为(5.80±0.11)h,与对照组(5.43±0.13)h比较有统计学差异(t手术时间=2.22,P=0.03);实验组患者胃肠功能恢复时间为(4.95±0.16)d与对照组(10.50±0.40)d比较有统计学差异(t胃肠恢复时间=3.22,P=0.00);实验组患者住院时间(10.20±0.12)d、患者下床活动时间(3.33±0.12)d以及术后体重(58.70±2.02)kg与对照组患者住院时间(10.50±0.40)d、患者下床活动时间(3.40±0.14)d以及术后体重(61.00±2.02)kg比较均无统计学意义(t住院时间=0.62,P=0.5;t下床时间=0.41,P=0.69;t体重=0.81,P=0.42);多吻合器手术时间比传统手术时间长,其胃肠功能恢复时间也比传统手术恢复晚。两组患者随访2年,两组中死亡病例均因其他系统疾病而导致,均无肿瘤复发病例,两组中位生存时间分别为10个月和11个月,统计学分析,两组差异无显著。结论对超低位直肠癌患者,采用确保切缘阴性的二或三吻合器法是安全可靠的,且具有直肠系膜切除完整,吻合可靠等优点,充分提高了超低位直肠癌患者保肛的成功率,同时避免了术后病理报告切缘阳性的尴尬局面,与传统手术相比提高了患者术后的患者生存质量。
Objective To investigate the safety and reliability of multiple anastomats for anal sphincter preservation in ultra-low rectal cancer anus-preserving surgery. Methods Forty patients with rectal cancer in our hospital were randomly divided into experimental group and control group according to random number method. There was no significant difference in sex, age, disease and concomitant disease between the two groups. The control group received traditional surgery Perineal rectal cancer radical surgery miles). In the experimental group, 11 patients underwent two anastomosis with two staplers and 9 patients underwent anal sphincter preservation by three staplers. All patients underwent surgical resection to ensure negative surgical margins. Follow-up observation of two groups of patients postoperative recovery time, hospital stay, postoperative complications, postoperative quality of life satisfaction and other indicators, while recording the survival of patients. Results There was no significant difference in gender, age, complication and pathological stage between the two groups. The operation time of the experimental group was (5.80 ± 0.11) h, which was significantly different from that of the control group (5.43 ± 0.13) h (t = 2.22, P = 0.03) ± 0.16) d was significantly different from that of the control group (10.50 ± 0.40) d (t = 3.22, P = 0.00). The hospitalization time of the experimental group was (10.20 ± 0.12) d, 3.33 ± 0.12) d, postoperative weight (58.70 ± 2.02) kg and hospital stay (10.50 ± 0.40) d in the control group, 3.40 ± 0.14 (d) and weight after operation (61.00 ± 2.02) kg (T hospital stay = 0.62, P = 0.5; t down time = 0.41, P = 0.69; t body weight = 0.81, P = 0.42); multi-stapler surgery time longer than the traditional operation, the stomach Intestinal function recovery time is also later than the traditional surgical recovery. Two groups of patients were followed up for 2 years, the deaths in both groups were caused by other systemic diseases, no tumor recurrence, the median survival time was 10 months and 11 months, respectively, statistical analysis, the difference between the two groups without Significant. Conclusion For patients with ultra-low rectal cancer, the use of two or three staplers to ensure negative margins is safe and reliable, and has the advantages of complete mesorectal excision, reliable anastomosis and so on, which fully improves the analgesic success rate in patients with ultra-low rectal cancer , At the same time avoiding the embarrassing situation of positive margins of postoperative pathological reports and improving the patients’ quality of life after surgery compared with traditional surgery.