支撑吻合法用于低位直肠癌保肛手术的临床研究

目的比较支撑吻合技术与DST双吻合技术(Double Stapling Technique,DST)行低位直肠癌保肛手术的临床效果、适应证选择及卫生经济学优劣。方法将60例肿瘤下缘距肛缘约4～6cm的低位直肠癌保肛手术患者,随机分为治疗组和对照组各30例。治疗组采用支撑吻合法,对照组采用DST双吻合技术,对两组疗效做对比。结果术后病理检测提示治疗组患者无远端肿瘤残留,对照组则有2例。肿瘤远端切除距离显示,治疗组平均为(2.81±0.35)cm,对照组平均为(1.73±0.42)cm。两组比较,具有统计学差异(P0.05)。治疗组术后两年均无吻合口复发,对照组则有4例,对照组复发率高于治疗组。治疗组术后早期排便功能较差,均能在1～3个月内改善。对照组术后排便功能正常,对照组和治疗组在近期肛门功能恢复上无统计学差异。治疗组术后无吻合口漏发生,对照组术后有3例吻合口漏,具有统计学差异(P0.05)。治疗组平均费用为(3.17±4.36)万元,明显低于对照组(4.40±4.72)万元,具有统计学差异(P0.05)。结论支撑吻合术对比DST双吻合技术用于低位直肠癌保肛患者治疗其疗效肯定,小样本临床观察近期复发率低,且制作成本低、操作方法简单,较之双吻合技术能节省1～1.5万元。在低位直肠癌患者术式选择中应根据患者经济条件、体型、骨盆宽窄、肿瘤分化程度及其侵犯肠管的周径合理选择支撑吻合技术或DST双吻合技术。

The clinical research of Supporting anastomosis method for anus-preserving operation for low rectal cancer

Objective Comparing supporting anastomosis and DST Double anastomosis （Double Stapling Technique, DST） line of low rectal cancer anal surgery clinical effect, indications and advantages and disadvantages of health economics. Methods Edge of 60 cases of tumor from anal edge about 4 - 6 cm of the patients with low rectal cancer anal surgery, were randomly divided into treatment group and control group 30 cases each. Treatment group support fit method, the control group USES the DST （Double Stapling Technique, DST） Double anastomosis; And two groups of curative effect comparison. Results Postoperative pathological detection of distal tumor residue, prompt treatment group patients in the control group had 2 cases. Distal tumor resection range, according to the treatment group is on average （2.81 ± 0.35 ） cm, the control group on average （ 1.73 ± 0.42 ） cm. Two groups of comparisons, with statistical difference （P %0. 05}. Treatment group after two years without anastomotic recurrence, the control group there were 4 cases, control group recurrence rate higher than the treatment group. Treatment group early postoperative bowel function is bad, all can improve in 1 - 3 months. Defecation function after surgery for control group, normal control group and treatment group in the near future there is no statistical difference of anal function recovery. Treatment group without postoperative anastomotic leakage occurs, the control group in 3 cases of anastomotic leakage, with statistical difference （ P 〈0.05 ）. Treatment group, on average, costs $ ten thousand a （3.17±4.36） yuan, significantly lower than the control group （4.40±4.72） ten thousand yuan, with statistical difference （ P 〈0. 05）. Conclusion Support contrast anastomosis DST double anastomosis for low rectal cancer protect anal curative effect on the patients, clinical observation of small sample recent recurrence rate is low, and low production cost, simple operation meth-od, compared with doubleanastomosis technique can save 1 - 15000 yuan. In patients with low rectal cancer operation selection should be based on patients＇ economic conditions, the size, the pelvis width size, degree of tumor differentiation and invasion insufflate the weeks reasonable choice anastomosis or DST double anastomosis.