Abstract:

Laparoscopic low anterior resection combined with “dog ear” invagination anastomosis for mid-and distal rectal neoplasm        ZHANG Liang，XIE Zhi-yuan，ZHANG Wen-tao，et al. Gastrointestinal Surgery, The Affiliated XuZhou Hospital of Medical College of Southeast University, Xuzhou Engineering Technology Research Center of Laparoscopic Diagnosis and Treatment, Xuzhou 221009，China
Corresponding author: LYU Xiao-peng，E-mail：lvxiaopeng2017@126.com
Abstract    Objective    To investigate the feasibility and outcome of laparoscopic low anterior resection combined with “Dog Ear” invagination anastomosis for mid-and distal rectal neoplasm.  Methods    The clinical data of 18 patients undergoing laparoscopic low anterior resection combined with “dog ear” invagination anastomosis in department of gastrointestinal surgery，the Affiliated XuZhou Hospital of Medical College of Southeast University from January 2015 to May 2016 were analyzed retrospectively，and technical notes were summarized.  Results    Laparoscopic low anterior resection combined with “dog ear” invagination anastomosis was performed successfully in 18 patients. No patients had conversion. Median operation time was 150（120～180）min. No fistulas occurred after surgery，one at anastomotic bleeding. No defunctioning stoma occurred in operation. Defecation frequency 3 months after surgery was （3.6±1.3）times per day. The mean Gastrointestinal Quality of Life was（92.8±12.1）points. Conclusion    Laparoscopic low anterior resection combined with “dog ear” invagination anastomosis is safe and feasible. Postoperative defecation and quality of life are satisfactoty. This modified surgery play a positive role in reducing the incidence of anastomotic leakage and defunctioning stoma.

Key words: rectal cancer, low anterior resection, double-stapling technique, anastomotic leakage, defunctioning stomas

摘要：

目的    探讨“dog ear”内陷式吻合在腹腔镜下直肠低位前切除吻合中的临床应用价值。方法    回顾性分析2015年1月至2016年5月徐州市中心医院胃肠外科收治的18例行腹腔镜手术治疗的直肠癌病人临床资料，均采用“dog ear” 内陷式吻合技术，观察并分析术后疗效。结果    18例病人均成功实施腹腔镜下两端角内陷式吻合术，无中转开放手术病例。手术时间150（120～180）min。术后无吻合口漏病例，1例病人术后发生吻合口出血。术中均未行预防性造口。术后3个月时随访病人平均排便次数（3.6±1.3）次/d。病人术后总体生活质量评价（GQL）为（92.8±12.1）分。结论   腹腔镜“dog ear” 内陷式吻合在直肠癌手术中安全可行，消除了因“dog ear”存在所造成的潜在吻合口漏风险。

关键词: 直肠癌, 直肠低位前切除术, 双吻合, 吻合口漏, 预防性造口