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目的探讨圆形吻合器在中低位直肠癌应用的安全性和临床效果。方法对233例中低位直肠癌施行圆形吻合器吻合保肛术的临床资料进行分析。结果术后随访率86.3%(201/233),中位随访时间60.1个月。术后发生吻合口瘘11例(4.7%)均发生在术后4～12d,4例保守治疗痊愈,7例采用横结肠造口,3～4个月后还纳。吻合口狭窄6例(2.6%)多发生在术后2～6个月,经扩肛持续均解除。术后局部复发率为5.9%(12/201),复发时间为术后2～3年内。肝转移发生率为10.4%(21/201),多发生在术后2～3年内。中位生存时间60.1个月。术后5年生存率67.0%。结论圆形吻合器在中低位直肠癌保肛术中应用操作快捷、吻合可靠、方便安全,疗效满意。
Objective To investigate the safety and clinical effect of circular stapler in low and middle rectal cancer. Methods The clinical data of 233 cases of rectal cancer with circular anastomosis and anal sphincter preservation were analyzed. Results The postoperative follow-up rate was 86.3% (201/233). The median follow-up time was 60.1 months. Anastomotic fistula occurred in 11 cases (4.7%) occurred after 4 ~ 12d, 4 cases of conservative treatment cured, 7 cases of transverse colonostomy, 3 to 4 months later satisfied. Anastomotic stenosis in 6 cases (2.6%) occurred in 2 to 6 months after surgery, were sustained by the anus were released. The local recurrence rate was 5.9% (12/201) and the recurrence time was 2 ~ 3 years after operation. The incidence of liver metastases was 10.4% (21/201), occurred more than 2 to 3 years after surgery. The median survival time of 60.1 months. The 5-year survival rate was 67.0%. Conclusions The circular stapler has the advantages of quick operation, reliable anastomosis, convenient and safe operation and satisfactory curative effect in the anal sphincter preservation of low and middle rectal cancer.