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目的介绍用支撑捆扎套入法完整保留齿状线和肛门内括约肌的超低位结肠肛管吻合术。方法87例低位直肠癌在完成全直肠系膜切除后,保留距离齿状线≤1cm的直肠,剥离直肠黏膜,保留齿状线。近端结肠内置入肛门支撑吻合管,经肛门拖出与直肠残端吻合。结果87例保留内括约肌的超低位结肠肛管吻合术无手术死亡及吻合口漏,随访2～60个月,随访率89%,无吻合口复发;盆腔内软组织肿瘤复发3例,闭孔淋巴结复发2例,异时肝转移6例。术后12个月吻合口狭窄6例。术后6个月对79例排便功能进行评价,平均每日排便2～3次,可以区分排气和排便,可以控制半成形便,排便不规律52例。结论低位直肠癌根治术后,支撑捆扎套入法可以完成保留肛门内括约肌的超低位结肠肛管吻合术。
Objective To introduce the ultra-low level colorectal anal canal anastomosis to retain the dentate line and the anal sphincter with the supportive lacing cerclage method. Methods 87 cases of rectal cancer after the completion of the total mesorectal excision, to keep the dentate line ≤ 1cm rectum, stripping rectal mucosa, retained dentate line. Proximal colon built into the anus support anastomosis tube, through the anus drag out and rectal stump anastomosis. Results There were no operative deaths and anastomotic leaks in 87 cases of internal anal sphincter preservation surgery. The patients were followed up for 2 to 60 months with a follow-up rate of 89% and no anastomotic recurrence. The pelvic soft tissue tumors recurred in 3 cases and the obturator lymph nodes Recurrence in 2 cases, heterotopic liver metastases in 6 cases. Anastomotic stenosis in 6 months after operation. Sixty-nine months after surgery, 79 patients were evaluated for defecation function, with an average of 2 to 3 defecation days per day, which could distinguish between excretion and defecation, and could control half-formed stools and irregular defecation in 52 cases. Conclusions After radical surgery of the lower rectal cancer, the labyrinthine labyrinthine anastomosis can be completed with the supportive labyrinth sheathing method.