中国实用外科杂志

中国实用外科杂志

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极低位直肠癌拖出式适形切除术中使用25号管状吻合器研究

孙    戈，龚海峰，楼    征，隋金珂，孟荣贵，郝立强，刘连杰，张    卫   

  1. 第二军医大学附属长海医院肛肠外科，上海200433
  • 出版日期:2018-04-01 发布日期:2018-03-30

  • Online:2018-04-01 Published:2018-03-30

摘要：

目的    探讨极低位直肠癌（肿块下缘至齿线<2 cm）适形切除术中使用25号管状吻合器的安全性及对术后并发症及控便功能的影响。方法    回顾性分析2011年1月至2016年11月海军军医大学附属长海医院收治的行直肠癌经肛拖出式适形切除术的52例极低位直肠癌病人的临床资料，术中均使用25号管状吻合器，并随访观察其术后并发症及控便功能情况。结果    所有病人均顺利完成手术，无围手术期死亡病例。均行R0切除，肿块下缘至肛缘距离为3.4（3～4）cm，远切缘距离为0.5（0.3～1.0）cm，肿瘤直径为3.0（2.0～3.7）cm，术中失血量87.5（60～200）mL，手术时间为144.5（111～183）min，住院时间为12.0（9～14）d，术后住院时间为7.0（6～8）d，清扫淋巴结数为14.0（12.0～15.8）枚。随访33.0(21.0~52.5)个月。8例病人发生早期并发症，包括1例术后早期尿潴留、1例肺炎、1例吻合口漏、1例骶前感染、4例切口感染。9例病人发生远期并发症，包括1例肠梗阻、1例吻合口炎症、4例吻合口狭窄、1例直肠阴道瘘、2例腹股沟疝。造口还纳术后3～12个月，病人排便功能逐步恢复。2例病人分别在术后4、24个月发生了吻合口局部复发；5例远处转移全部发生在术后2年内。3年无进展存活率、总存活率分别为87.2%、98.0%。结论    极低位直肠癌适形切除术中使用25号吻合器安全可靠，不增加吻合口漏与吻合口狭窄等并发症的发生，并且可以更好地保护排便功能。

关键词: 极低位直肠癌, 排便功能, 管状吻合器, 吻合口狭窄, 适形切除术

Abstract:

Study of size 25 circular stapler in conformal sphincter preservation operation of very low rectal cancer                       SUN Ge，GONG Hai-feng，LOU Zheng，et al. Department of Colorectal Surgery，Changhai Hospital of Second Military Medical University，Shanghai 200433，China
Corresponding author：ZHANG Wei，E-mail:weizhang2000cn@163.com
Abstract    Objective    To investigate the effect of size 25 circular staplers in conformal sphincter preservation operation (CSPO) on postoperative complications and defecation function of very low rectal cancer. Methods    The clinical data of 52 very low rectal cancer patients who accepted conformal sphincter preservation operation (size 25 circular staplers) in Department of Colorectal Surgery of Shanghai Changhai Hospital from January 2011 to November 2016 were analyzed retrospectively. The postoperative complications and fecal function were recorded in the follow up. Results    All the patients finished the operation successfully with R0 resection and no perioperative mortality. The distance from the lower edge of the tumor to the anal verge was 3.4(3-4)cm, the distal resection margin 0.5(0.3-1.0)cm, the tumor diameter3.0(2.0-3.7) cm, blood loss 87.5 (60-200) mL, operation time 144.5 (111.8-183.0) min, hospital stays12.0(9-14) days, postoperative hospital stays 7.0(6-8)d, and number of lymph nodes 14.0(12.0-15.8). The follow up time was 33.0(21.0-52.5)mon.8 patients developed early complications including one case of urinary retention, one case of pneumonia, one case of anastomotic leakage, one case of presacral infection and four cases of wound infection. Nine patients developed late complications, including one case of intestinal obstruction, one case of anastomotic inflammation, 4 cases of anastomotic stenosis, one case of rectovaginal fistula and 2 cases of inguinal hernia. Three to 12 months afterthe ileostomy closure, the bowel function recovered gradually. Two patients underwent anastomotic recurrence in the 4th and 24th month after the surgery respectively; Five distant metastases all happened within 2 years postoperatively. The 3-year PFS rateand OS rate were 87.2% and 98.0% respectively. Conclusion    Size 25 circular staplers can be used safely and reliably in conformal sphincter preservation operation without increasing the incidence of anastomotic leakage and anastomotic stenosisas well as getting a better defecation function.

Key words: very low rectal cancer；defecation function；circular stapler, anastomotic stricture；conformal sphincter preservation operation