医药学论文：全直肠系膜切除联合双器械吻合在低位直肠癌保肛术中的应用

【摘要】 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方法和临床疗效。方法 在全直肠系膜切除的基础上，应用双器械吻合技术，对103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 中低位吻合31例，超低位吻合72例；无切端癌残留，无大便失禁，无吻合口漏；全组无手术死亡；肿瘤局部复发率5.8%（6/103）。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。
【关键词】 直肠癌；保肛手术；双器械吻合；全直肠系膜切除术
Application of double stapling technique combined with total mesorectal excision for anus preservation operation on low position rectal cancer
【Abstract】 Objective To investigate the specific method and therapeutic yield of application of double stapling technique combined with total mesorectal excision for anus preservation operation on low position rectal cancer.Methods Using DTS combined with TME，103 cases of low position rectal cancer operated with low or ultralow colorectal anastomosis were analyzed，including the radical cure effect and the operative mergence symptom and the function of defecation.The cases were followed for 3 years.Results 31 cases were performed on with low colorectal anastomosis，72 cases were performed on with ultralow colorectal anastomosis.There was not tumor remaining.There was no operation death，leakage of anastomotic opening and incontinence of feces in the group.Local recurrence rate was 5.8%(6/103) in the follow up period.Conclusion Total mesorectal excision combined with double stapling technique is not only an effective method to maintain function of defecation in lower cancer，but also，to improve the living quality of patients and reduce local reccurrence.
【Key words】 rectal cancer；anus preservation operation；double stapling technique；total mesorectal excision

1 资料与方法
一般资料 本组103例，其中男58例，女45例；年龄31～76岁（平均53.6岁）；肿瘤下缘距肛缘3～5cm者65例，5～7cm者38例。肿瘤肉眼分型：隆起型18例，局限溃疡型55例，浸润溃疡型24例，弥漫浸润型6例。病理分类：高分化腺癌48例，中分化腺癌42例，低分化腺癌7例，黏液腺癌6例。Dukes分期：A期15例，B期59例，C期23例，D期6例。
1.2 手术方法 所有病例均遵循无瘤操作、全直肠系膜切除采用Heald法，即采用全直肠系膜切除加双器械吻合行中低位直肠癌切除术，腹腔及盆腔操作步骤同Miles术，吻合器及闭合器采用美国强生公司"ETHICON"系列产品。
2 结果

3 讨论
直肠全系膜切除术或称为系膜完整切除术近年来引起临床外科医师的重视。由著名英国外科学者Heald等提出［2］，经过10余年的不懈努力及推广，该理论及临床应用越来越广泛。Enker［3］称TME为低位直肠癌手术治疗新的金标准，指出：作为TME的结果，5年生存率自45%～50%上升至75%，局部复发率从30%降至5%～8%，中下段直肠癌的括约肌保留手术至少上升了20%，阳痿和膀胱功能障碍从50%～85%降至15%以下。