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目的探讨弧形切割闭合器在低位直肠癌超低位前切除术中的应用价值。方法对2006年1月—2010年12月由同一组主刀医师完成63例低位直肠癌根治性切除的患者进行前瞻性研究。患者在全直肠系膜切除和侧方淋巴结清扫的基础上,随机分组分别应用弧形切割吻合器(观察组)与直线型闭合器(对照组)对直肠(肛管)残端进行切割、闭合,用32 mm弯形管型吻合器进行超低位结肠―直肠(肛管)吻合术,比较两组的优缺点。结果术中采用弧形切割闭合器的32例低位直肠癌患者无切割和闭合不全者,术后无1例发生吻合口瘘;手术时间明显缩短[(117.3±37.5)min vs.(149.3±42.4)min,P<0.05)],术后并发症发生率明显低于对照组(9.4%vs.19.4%,P<0.05),保肛成功率亦高于对照组[100%(32/32)vs.90.3%(28/31),P<0.05]。结论弧形切割闭合器在低位直肠癌超低位前切除术中具有切割完整、闭合确实、手术时间短、相关并发症发生率低、中转Miles术少的优点,具有良好的应用推广前景。
Objective To investigate the value of curved incision closure in the treatment of low rectal cancer. Methods From January 2006 to December 2010, 63 patients with radical resection of lower rectal cancer were prospectively studied by the same surgeon. On the basis of total mesorectal excision and lateral lymph node dissection, the patients were randomly divided into two groups: the incision of the rectum (anal canal), the incision of the rectum (anal canal), the incision of the rectum (anal canal) Ultra-low level colorectal (anal) anastomosis was performed with a 32 mm curved tube stapler to compare the advantages and disadvantages of the two groups. Results There was no incision and incomplete closure in 32 cases of low rectal cancer patients who underwent arc-shaped incision closure. No anastomotic fistula occurred after operation. The operative time was significantly shortened [(117.3 ± 37.5) min vs. (149.3 ± 42.4 ) min, P0.05). The incidence of postoperative complications was significantly lower than that of the control group (9.4% vs.19.4%, P <0.05), and the success rate of anal retention was also higher than that of the control group (100%, 32/32) vs.90.3% (28/31), P <0.05]. Conclusions Curved cutting device has the advantages of complete cutting, exact closure, short operative time, low complication rate and fewer Miles transplants in low anterior resection of low rectal cancer. It has good prospect of application and popularization.