腹腔镜下低位直肠癌保肛术中支撑吻合管的应用价值

【摘要】〓目的〓探讨腹腔镜下低位直肠癌保肛术中支撑吻合管的应用价值。方法〓腹腔镜下对14例低位直肠癌病人实施全直肠系膜切除(TME)根治性切除,用支撑吻合管完成超低位结直肠-肛管吻合术。结果〓超低位结直肠-肛管吻合成功14例,吻合时间l5~30 min,直肠系膜均完整切除,其中结肠与外科肛管吻合8例,结肠与解剖肛管吻合6例。术后病人肛门括约肌功能、排尿功能良好,未发生吻合口狭窄与吻合口瘘者。术后6个月排便功能优良率为85.71%(12/14)。寿命表法计算5年生存率和局部复发率分别为78.57%(11/14)及7.14%(1/14)。结论〓腹腔镜下低位直肠癌保肛术中支撑吻合管的应用是安全可行的。

Value of anus preserving operation with sustaining anastomotic tube in laparoscope for lower rectal cancer

Objective To assess the value of anus preserving operation with sustaining anastomotic tube in laparoscope for lower rectal cancer. Methods The alimentary tract reconstruction by colorectal （anal） anastomoses with a sustaining anastomotic tube through anal in laparoscope after TME in 14 cases of lower rectal cancer. Results Forteen ultralow colo-rectaL/anal anastomoses were successfully completed laparoscopically and the anastomosis time was 15-30 min. The mesorectum was cut completely. The distance from stoma to the dentate line was less than 2 cm in 8 patients and colo-anal anastomosis was performed in 6 patients. The function of anal sphincter and micturition recovered smoothly after the operation without anastomotic stoma leakage and anastomotic stoma stenosis. The defecation function was satisfactory in 85.71% （12/14） cases. Postoperative 5 year survival and recurrence were 78.57% （11/14）, 7.14% （1/14） respectively by life table method. Conclusion The anus preserving operation with sustaining anastomotic tube is safe and practicable in laparoscope for lower rectal cancer.