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目的 探讨双器械吻合技术联合全直肠系膜切除在低位直肠癌保肛手术中的应用和疗效。 方法 在全直肠系膜切除的基础上 ,应用双器械吻合技术 ,对 5 3例低位直肠癌行低位或超低位吻合。随访 3年 ,回顾性分析其根治性、术后排便功能、手术并发症、局部复发率。 结果 低位吻合 12例 ,超低位吻合 4 1例。无切端癌残留 ,全组无手术死亡 ,无吻合口漏。本组均随访 3年 ,6个月内每日大便次数 5～ 10次者 18例 ,余者均在 5次以下 ,6个月后所有患者大便次数均在 5次以下 ,无大便失禁。吻合口狭窄发生率 3.8% (2 / 5 3) ,肿瘤局部复发率 5 .7% (3/ 5 3)。 结论 在全直肠系膜切除基础上 ,利用双器械吻合技术行低位直肠癌保肛手术是保持排便功能 ,减少并发症 ,减少局部复发 ,提高生活质量的有效方法。
Objective To investigate the application and efficacy of dual-instrument anastomosis combined with total mesorectal excision in the anorectal surgery of low rectal cancer. Methods On the basis of total mesorectal excision, double-instrumental anastomosis technique was used to perform the anastomosis of low or ultra-low level in 53 cases of low rectal cancer. The patients were followed up for 3 years. The curative effect, postoperative defecation function, operative complications and local recurrence rate were retrospectively analyzed. The results of low anastomosis in 12 cases, 41 cases of ultra-low anastomosis. No end-cancer residual, the whole group without surgical death, no anastomotic leakage. This group were followed up for 3 years, 6 months, the number of daily stool 5 to 10 times in 18 cases, the remaining were less than 5 times, 6 months after all patients stool frequency are less than 5 times, no incontinence. The incidence of anastomotic stenosis was 3.8% (2/53), and the local recurrence rate was 5.7% (3/53). Conclusions On the basis of total mesorectal excision, double anastomosis technique is an effective method to maintain defecation, reduce complications, reduce local recurrence and improve quality of life in low rectal cancer.