直肠全系膜切除联合双吻合器在低位直肠癌保肛术中的应用

目的探讨直肠全系膜切除术（TME）联合双吻合器（DST）在低位直肠癌保肛术中的应用价值,提高临床手术水平。方法对本院2007年1月～2012年1月收治的105例直肠癌手术患者的临床资料进行回顾性分析,均给予TME联合DST治疗,观察手术疗效及随访情况。结果本组105例患者手术均成功。术中吻合均一次成功,无再次吻合病例。术后并发症包括吻合口瘘5例（4.8%）、神经性膀胱排空障碍3例（2.8%）、切口感染2例（1.9%）,无吻合口出血、狭窄等并发症。术后住院时间为11～29d,平均（15.6±3.7）d。术后随访12～36个月,失访17例,随访成功率为83.8%。随访期间死亡15例,死亡率为17.0%;术后复发4例,复发率为4.5%;发生肠粘连2例,给予保守治疗后消失。其余患者均存活,无其他远期并发症发生。结论 TME联合DST在低位直肠癌保肛术中应用效果良好,可减少术后相关并发症、改善预后,值得推广应用。

Application of total mesorectal excision combined with double stapling technique in reserving anus surgery of low rectum cancer

Objective To investigate the application value of total mesorectal excision （TME） combined double stapling technique （DST） in reserving anus surgery of low rectum cancer and improve the level of clinical operation. Methods The clinical data of 105 patients with rectum cancer admitted to our hospital from January 2007 to January 2012 were retrospectively analyzed.All patients were treated by TME combined with DST.The therapeutic effect of operation and circumstances of follow-up was observed.Results All the 105 patients in this study received successful operation.Intra-operative anastomoses were successful operated with no case of rework.The postoperative complications included 5 cases （4.8%） of anastomotic leakage, 3 cases （2.8%） of neurogenic bladder emptying disorder, and 2 cases （1.9%） of wound infection.There were no other complications such as anastomotic bleeding and stenosis.The postoperative hospital stay was 11-29 d,average of （15.6±3.7） d.The postoperative follow-up lasted for 12-36 months with success rate of 83.8% and 17 cases lost.There were 15 cases died during follow-up period with mortality of 17.0%;4 cases recurred with recurrence rate of 4.5%;2 cases arose intestinal adhesions cured by conservative treatment.The remaining patients were alive,no other long-term complications occurred.Conclusion TME combined with DST has well applying effect in reserving anus surgery of low rectum cancer,can reduce related postoperative complications and improve prognosis,thus is worth widely applying.